Appeals Specialist II

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. reputed company is a reputed company, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Supports the documentation and processing of appeals, disputes and reconsiderations to ensure they... are in accordance with state and National Committee for Quality Assurance (NCQA) requirements. Support the team to ensure appeals, disputes and reconsiderations are reviewed and processed timely. • Performs data entry to support the tracking, logging, and processing of appeals, disputes and reconsiderations in accordance with established regulatory and accreditation guidelines and procedures • Prepares correspondence for appeals, disputes and reconsiderations and maintains documentation files • Reviews and investigates appeals, disputes and reconsiderations requests to determine applicable follow up • Conducts research needed to evaluate, process, and respond to appeals, disputes and reconsiderations to ensure a timely decision • Prepares case files including supporting documentation and determinations needed to review, process, and report the appeals, disputes and reconsiderations • Gathers appeals, disputes and reconsiderations data to track and report on trends and final outcomes to team including conducting reputed company for an update on statuses, determinations, and explanations • Performs other duties as assigned • Complies with reputed company policies and standards Education/Experience: Requires a High School diploma or GED. Requires 1 – 2 years of reputed company experience. Knowledge of appeals, disputes and reconsiderations process preferred. Pay Range: $19.62 - $33.36 per hour reputed company offers a comprehensive benefits package including: reputed company, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company factors permitted by law. Total compensation may also include additional forms of incentives. reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law. reputed company applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act Apply Job!