Remote Grievances & Appeals Specialist

TEKsystems; United States; Remote; USD 27,000 - 39,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k) plan

Life Insurance

Disability

Health Savings Account

Paid time off

Job summary

TEKsystems is urgently hiring multiple remote Grievances and Appeals coordinators. Open to candidates based in CA, AZ, NV, NM, or TX. Requires 1 year grievances/appeals experience; reliable internet; Medicare Advantage preferred.

Role pays $24/hr and is fully remote in a contract capacity. Responsibilities include investigating grievances, gathering documentation, communicating with members/providers, and coordinating with RN/management.

Qualifications

• Must have at least 1 year of recent grievances and appeals experience.
• Reliable internet and experience working remotely.
• Medicare Advantage plan is highly preferred.
• 2-3 years of experience within grievances and appeals in a healthcare setting.
• Basic technical skills: Microsoft Word, Excel, Outlook.

Responsibilities

• Investigates member grievances and appeals by gathering documentation from internal departments, PO, and others.
• Communicates with members or providers to request information and follow up as needed.
• Refers case to RN or management as needed.
• Tracks movement of cases through SCAN units to meet timelines.
• Responds to information requests from regulatory agencies within required timeframes.
• Closes cases within designated regulatory time requirements and sends communications.
• Maintains knowledge of SCAN benefit structure relevant to Grievances and Appeals.
• Uses department procedures and training materials; reports barriers to supervisor.
• Covers weekend on-call rotation and preserves member privacy.
• Adheres to quality, compliance and regulatory standards.

Skills

Grievances

Appeals

Healthcare

Medicare

Managed Care

Medical Terminology

Education

High School Diploma

Tools

MS Office

IKA

MHK

QNXT

Job description

TEKsystems is urgently hiring multiple remote Grievances and Appeals coordinators. Open to candidates based in CA, AZ, NV, NM, or TX. Requires 1 year grievances/appeals experience; reliable internet; Medicare Advantage preferred.

Role pays $24/hr and is fully remote in a contract capacity. Responsibilities include investigating grievances, gathering documentation, communicating with members/providers, and coordinating with RN/management.