Enjoy the freedom and flexibility of working from your home office on a steady schedule with weekend-free downtime. You will play a vital role in investigating issues, analyzing clinical records, carrying out necessary resolutions, and directly communicating findings to members and providers. If you thrive in a supportive, democratized team culture where your ideas are valued and your writing and problem-solving skills can shine, this is the perfect opportunity to advance your healthcare operations career.
salary: $22.99 - $23 per hour
shift: First
work hours: 8 AM - 5 PM
education: High School
Responsibilities
Position Summary:
Analyze and resolve verbal and written claims and authorization appeals from providers, as well as formal grievances from members. Research issues, compile necessary documentation, and draft comprehensive response letters in accordance with regulatory standards.
Key Responsibilities:
- Process incoming member and provider grievances and appeals, aiming for target daily case completions.
- Research root causes of complaints, carry out necessary corrective actions, and draft formal written response letters.
- Gather and compile clinical records and criteria to route complex appeals to clinical teams for review.
- Maintain accurate, individual appeal and grievance files and system documentation.
- Assist with departmental initiatives, data entry, and incoming document management (scanning, logging, and filing).
- High School Diploma or GED required (Associate degree preferred).
- 2+ years of experience in managed care, grievances, appeals, or claims processing.
- Strong written, verbal, and analytical problem-solving skills.
- Proficiency in Microsoft Office Suite applications.
Skills
Qualifications
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: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).
This posting is open for thirty (30) days.
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
