Remote MA Appeals & Grievances Specialist

Blue Cross and Blue Shield of Kansas; Kansas City (MO); Remote; USD 39,000 - 45,000; Full time

Benefits offered by this job

Health/Vision/Dental insurance

6 weeks paid parental leave

Fertility/Adoption assistance

2 weeks paid caregiver leave

401(k) plan matching up to 5%

Tuition reimbursement

Health & fitness benefits

Job summary

The MA Appeals and Grievances Specialist provides a world class customer service experience through processing and resolution of Medicare Advantage (MA) member, member representative, or provider appeals and grievances. This remote-friendly role requires strong regulatory knowledge and the ability to coordinate with internal stakeholders to resolve complex cases.

Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment, with experience in MA/Medicaid

Qualifications

• Minimum 2 years' customer service experience.
• Minimum 3 years' MA or Medicaid Appeals and Grievances experience.
• Minimum 2 years' MA or other call center or production-based customer service experience.
• Previous experience with Blue Plan preferred.

Responsibilities

• Process MA appeals, grievances, and related inquiries to regulatory standards.
• Analyze MA benefits language and organizational policies to resolve issues.
• Prioritize and manage workload in a dynamic environment.
• Collaborate with internal teams, CMS caseworkers, providers, and members.
• Serve as backup to MA Customer Experience Representatives.
• Complete special projects related to appeals, grievances, or CXR duties.

Skills

Empathy

Analytical thinking

Regulatory knowledge

Research skills

Communication

Time management

Conflict resolution

Attention to detail

Education

High school diploma or equivalent

College courses in communications/medical fields

Job description

The MA Appeals and Grievances Specialist provides a world class customer service experience through processing and resolution of Medicare Advantage (MA) member, member representative, or provider appeals and grievances. This remote-friendly role requires strong regulatory knowledge and the ability to coordinate with internal stakeholders to resolve complex cases.

Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment, with experience in MA/Medicaid