This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more.

Role Description

The Redetermination (Appeals) Specialist supports the Medicare Appeals team by performing non-medical reviews, preparing redetermination letters, and ensuring timely and accurate processing. This role requires strong organizational skills, attention to detail, and the ability to work with reports, documentation, and multiple software tools in a fast-paced environment.

• Perform non-medical reviews and process redetermination letters, ensuring accuracy and compliance with established timelines (50%)
• Prepare unit reports, analyze and interpret workload data, and address processing issues using various software tools (30%)
• Update letters, templates, and departmental documents as needed (10%)
• Gather and prepare documentation for legal inquiries and administrative requests (10%)

Qualifications

• High School Diploma or equivalent required
• Associate’s or Bachelor’s degree preferred
• Minimum of 2 years of relevant experience in healthcare, insurance, or Medicare/Medicaid services
• Customer service experience preferred
• Medicare-specific experience preferred but not required; comprehensive training provided

Requirements

• Proficiency with Microsoft Office (Word, Excel, Outlook)
• Strong organizational skills with excellent attention to detail
• Effective written and verbal communication skills
• Demonstrated ability to exercise sound judgment and handle confidential information
• Strong spelling, grammar, and punctuation skills

Benefits

• 401(k) & matching
• Dental insurance
• Vision insurance
• Health insurance
• Life insurance
• Paid Time Off (PTO)
• Paid Holidays