Remote Medicare Appeals & Grievances Specialist

Blue Cross Blue Shield of Kansas; Topeka (KS); Hybrid; USD 38,000 - 45,000; Full time

Benefits offered by this job

Incentive pay program (EPIP)

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

Blue Cross and Blue Shield of Kansas is seeking an MA Appeals and Grievances Specialist to provide world-class customer service through processing and resolution of MA member, member representative, or provider appeals and grievances. The role requires interpreting MA benefits, policies, and regulatory guidance, coordinating with internal teams, and ensuring timely resolutions.

This position supports remote or onsite work in Kansas/Missouri with standard benefits and opportunities for

Qualifications

• High school diploma required.
• College or continuing education in communications or medical related fields preferred.
• 2+ years customer service experience required.
• 3+ years MA or Medicaid Appeals/Grievances experience required.
• 2+ years call center or production-based customer service preferred.

Responsibilities

• Process MA member, member representative or provider appeals and grievances to ensure regulatory guidelines are met.
• Interpret and analyze MA benefit offerings and relevant policies to resolve issues.
• Prioritize and manage workload to meet internal/regulatory deadlines in a fluctuating environment.
• Make judgment calls using discretion to review information and determine appropriate actions.
• Develop working relationships with staff, Plans, CMS caseworkers, providers and members for timely resolutions.
• Serve as a back-up to MA Customer Experience Representatives and respond to inquiries via phone, email, and written communications.
• Complete special projects related to appeals, grievances or related responsibilities.

Skills

Empathy

Communication

Research

Analytical thinking

Problem solving

Teamwork

Confidentiality

Time management

Education

High school diploma

Courses in communications/medical fields

Job description

Blue Cross and Blue Shield of Kansas is seeking an MA Appeals and Grievances Specialist to provide world-class customer service through processing and resolution of MA member, member representative, or provider appeals and grievances. The role requires interpreting MA benefits, policies, and regulatory guidance, coordinating with internal teams, and ensuring timely resolutions.

This position supports remote or onsite work in Kansas/Missouri with standard benefits and opportunities for