Remote MA Appeals & Grievances Specialist — Impactful Work

Blue Cross and Blue Shield of Kansas; Kansas; Remote; USD 57.000 - 68.000; Vollzeit

Benefits dieser Stelle

6 weeks paid parental leave

Fertility/Adoption assistance

2 weeks paid caregiver leave

401(k) plan matching to 5%

Health & fitness benefits

Zusammenfassung

Blue Cross and Blue Shield of Kansas seeks a MA Appeals and Grievances Specialist to process and resolve member, provider, and representative appeals and grievances, delivering world-class customer service.

The role supports remote or onsite work per policy; candidates must reside in Kansas or Missouri or be willing to relocate. You will interpret MA benefits, collaborate with CMS caseworkers, and maintain strong regulatory knowledge.

Qualifikationen

• High school diploma or equivalent required.
• College or continuing education courses in communications and/or medical fields preferred.
• Minimum 2 years customer service experience.
• Minimum 3 years MA or Medicaid Appeals and Grievances experience.
• Minimum 2 years MA or call center or production-based customer service experience preferred.
• Experience with Blue Plan preferred.

Aufgaben

• Process MA member, provider appeals, grievances per regulatory guidelines.
• Analyze MA benefits, policies and procedures to resolve issues.
• Prioritize workload to meet internal and regulatory deadlines.
• Consult internal/external contacts to determine appropriate actions.
• Build working relationships with staff, CMS caseworkers, providers and members.
• Back up MA Customer Experience Representatives as needed.
• Complete special projects related to appeals or grievances.

Kenntnisse

Empathy

Analytical skills

Communication skills

Research ability

Time management

Team collaboration

Ausbildung

High school diploma or equivalent

Communications or medical-related coursework preferred

Tools

MA/Regulatory knowledge

Blue Plan systems familiarity

Jobbeschreibung

Blue Cross and Blue Shield of Kansas seeks a MA Appeals and Grievances Specialist to process and resolve member, provider, and representative appeals and grievances, delivering world-class customer service.

The role supports remote or onsite work per policy; candidates must reside in Kansas or Missouri or be willing to relocate. You will interpret MA benefits, collaborate with CMS caseworkers, and maintain strong regulatory knowledge.