Medicare Appeals Specialist - Remote (PST)

Molina Healthcare; Arizona; Remote; USD 29,150 - 52,858; Full time

Benefits offered by this job

Competitive benefits and compensation package

Equal Opportunity Employer

Job summary

A healthcare provider is seeking a Medicare Appeals & Grievances Specialist to handle member appeals and grievances. This remote position requires strong experience in managed care, particularly with Medicare regulations. Ideal candidates will have excellent attention to detail, organizational skills, and proficiency in Microsoft Office. The role offers an hourly pay range of $21.16 - $38.37, depending on qualifications and location.

Qualifications

• At least 2 years of experience in a call center, appeals, or claims environment.
• Health claims processing experience including COB and subrogation.
• Customer service experience.
• Strong organizational skills with ability to manage multiple tasks.

Responsibilities

• Research and resolve appeals and grievances within regulatory timelines.
• Prepare appeal summaries and correspondence.
• Contact members/providers via written and verbal communication.

Skills

Understanding of UM and Appeals

Knowledge of Medicare regulations

Attention to detail

Verbal and written communication skills

Proficiency in Microsoft Office

Education

Managed care experience

Vocational program in health care (preferred)

Job description

A healthcare provider is seeking a Medicare Appeals & Grievances Specialist to handle member appeals and grievances. This remote position requires strong experience in managed care, particularly with Medicare regulations. Ideal candidates will have excellent attention to detail, organizational skills, and proficiency in Microsoft Office. The role offers an hourly pay range of $21.16 - $38.37, depending on qualifications and location.