Appeals and Grievance Specialist

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $18 / hour

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

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Sagility

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚖️ Legal

📦 Logistics

Healthcare • Legal • Logistics

Sagility is a company focused on digital privacy and online user experience, with an emphasis on cookie management and compliance with EU cookie laws. It provides tools and information for managing cookies, ensuring legal compliance, and enhancing website functionality and user privacy. Sagility aims to help businesses understand site visitors' interactions through necessary and optional cookies while maintaining data protection standards.

📋 Description

• Manage and resolve complaints, grievances, and appeals from members and providers • Serve as the primary contact throughout the investigation and resolution process • Send acknowledgments and provide clear education on the grievance and appeal process • Gather relevant information and research case details to determine an appropriate resolution • Conduct fair, accurate, and timely case investigations • Communicate resolutions to appropriate internal and external parties • Ensure all required documentation is completed and maintained • Follow established policies, procedures, and regulatory requirements • Maintain productivity and quality standards in a structured workflow environment • Participate on camera during interviews, training, team meetings, and regular check-ins

🎯 Requirements

• 1+ year of Medicare Appeals and Grievance or Medicare Claims experience required • Experience with Medicare Part C or Part D preferred • Familiarity with Windows-based computer systems and ability to learn new applications • Strong technical and keyboarding skills • Excellent verbal and written communication skills • Ability to stay focused and productive in repetitive task-based work • High School Diploma or equivalent • Availability for assigned Monday-Friday schedules between 8:00 AM and 5:00 PM Pacific Time • Ability to participate on camera during interviews, training, team meetings, and regular check-ins • Background checks, previous employment verifications, and education verifications may be conducted based on position requirements

🏖️ Benefits

• Medical, Dental, and Vision coverage • Life Insurance • Short-Term and Long-Term Disability options • Flexible Spending Account (FSA) • Employee Assistance Program • 401(k) with employer contribution • Paid Time Off (PTO) • Tuition Reimbursement • Weekly pay • Remote work arrangement • On-camera participation with face-to-face collaboration and a supportive team atmosphere