Appeals and Grievances Administrator

About the Role

We’re looking for the next generation of health care leaders. At AmeriHealth Caritas, we’re passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Responsibilities

• Screen calls from members and providers regarding the Part C, Part D, and Medicare-Medicaid Plan grievance processes.
• Serve as a backup to retrieve grievances from the Customer Service database and email distribution lists, assigning them appropriately to Grievance Investigators.
• Support grievance needs of our Medicare Advantage D-SNP and MMP membership.
• Complete First Call Resolution cases, including intake, determining if the case is fully resolved, generating letters, and closing the case.
• Convert unresolved cases to standard grievances and assign to an investigator.
• Generate Acknowledgement Letters to mail to appellants and answer general appeal status questions.
• Assist Investigation Specialists with grievance resolutions.
• Monitor work queues with limited availability on weekends and holidays.

Qualifications

• High School/GED (Associate’s Degree preferred)
• 1 to 3 years of Medicare/Medicaid experience
• Minimum of 2 years of experience dealing with the public
• Medicare Advantage and MMP experience
• Medical terminology, ICD, CPT, and coding experience
• Experience handling multiple call lines and triaging calls

Benefits

• Flexible work solutions including remote options and hybrid work schedules
• Competitive pay
• Paid time off including holidays and volunteer events
• Health insurance coverage for you and your dependents on Day 1
• 401(k)
• Tuition reimbursement

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.