salary: $17 - $17 per year
work hours: 8 AM - 5 PM
Coordinating the intake of appeal and grievances requests from members and providers into the designated systems.
Generating Acknowledgement Letters to mail to appellants and answering general appeal status questions. Compiling case files to be sent to Independent Review Entity (IRE). Ensuring adherence with state and federal regulatory timeframes for handling cases including acknowledging cases, resolving cases, monitoring effectuation of resolution, completing resolution letters and communicating with members and providers within required timeframes. Preparing case files for Independent Review Entities or other escalated types of cases, including documentation of the Statement of Position and case narratives. Developes and maintains positive customer relations and coordinates with variousfunctions within the company to ensure customer requests and questions are handled appropriately and in a timely manner. Participates in special projects and performs other duties as assigned.
- Working Independently
- Answering Phones
- Grievances / Appeals (2 years of experience is required)
- Oral Communication
- Billing (2 years of experience is required)
- Enrollment (2 years of experience is required)
- Medical Terminology (2 years of experience is required)
- Microsoft Office (2 years of experience is required)
- Bilingual Spanish/English (2 years of experience is required)
- Decision Making
- Written Communication
- Years of experience: 2 years
- Experience level:
Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad.
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.
At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.
Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including health, an incentive and recognition program, and 401K contribution (all benefits are based on eligibility).
For certain assignments, Covid-19 vaccination and/or testing may be required by Randstad's client or applicable federal mandate, subject to approved medical or religious accommodations. Carefully review the job posting for details on vaccine/testing requirements or ask your Randstad representative for more information.