Job Summary

Medical Grievance/Appeals Rep I

  • Location:
    Miami, Florida
  • Job reference:
  • Category:
    Content/Document Management
  • Contract Type:

Hiring for a Medical Grievance and Appeals Representative I job in Miami Florida!
Job Description:
5-month Contract with possibility for extension based on performance and fit
Miami FL 33174
Medical Claims Processing Experience Required
Intake coordinator for claim appeal disputes
Knowledge of Medicare / Medicaid guidelines for claim disputes
Responsible for reviewing, analyzing and processing claims in accordance with policies and claims events to determine the extent of the company's liability and entitlement.
Primary duties may include, but are not limited to:

  • Conducts investigation and review of customer grievances and appeals involving provision of service and benefit coverage issues.
  • Contacts customers to gather information and communicate disposition of case; documents interactions.
  • Generates written correspondence to customers such as members, providers and regulatory agencies.
  • Performs research to respond to inquiries and interprets policy provisions to determine the extent of company's liability and/or provider's/beneficiaries entitlement.
  • Responds to appeals from CS Units, Provider Inquiry Units, members, providers and/or others for resolution or affirmation of previously processed claims.
  • Ensures appropriate resolution to inquiries, grievances and appeals within specified time frames established by either regulatory/accreditation agencies or customer needs. Identifies barriers to customer satisfaction and recommends actions to address operational challenges.
  • Requires a HS diploma or equivalent; 1-3 years experience in health insurance business including customer service experience; or any combination of education and experience, which would provide an equivalent background.
  • Good verbal and written communication, organizational and interpersonal skills. PC proficiency.

If you are interested in applying for this Medical Grievance/Appeals Rep I job in Miami FL please apply now!

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All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.

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