Medicare Advantage Appeals and Grievances Customer Experience Specialist

This job was posted by https://www.kansasworks.com : For more information, please see: https://www.kansasworks.com/jobs/13687834 **Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.** You Belong At Blue Why Join Us?** **Make a Positive Impact:** Your work will directly contribute to the health and well-being of Kansans. **Family Comes First:** Total rewards package that promotes the idea of family first for all employees. Paid vacation and sick leave with paid maternity and paternity available immediately upon hire **Professional Growth Opportunities:** Advance your career with ongoing training and development programs. **Dynamic Work Environment:** Collaborate with a team of passionate and driven individuals in a work environment that promotes flexibility. **Trust and Stability:** Work for one of the most trusted companies in Kansas with over 80 years of commitment, compassion and community. **Inclusive Work Environment:** We pride ourselves on fostering a workplace where everyone is valued and respected. **Benefits & Perks** Base compensation is only one component of your competitive Total Rewards package Incentive pay program (EPIP) Health/Vision/Dental insurance 6 weeks paid parental leave for new mothers and fathers Fertility/Adoption assistance 2 weeks paid caregiver leave 401(k) plan matching up to 5% Tuition reimbursement Health & fitness benefits, discounts and resources **Job Summary** The MA Appeals and Grievances Specialist provides a world class customer service experience through processing and resolution of Medicare Advantage (MA) member, member representative, or provider appeals and grievances. May also process and resolve member, representative, provider, and other Blue Plan inquiries. **Work Location:** This position is eligible to work remotely or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment. **What you\'ll do** Process MA member, member representative or provider appeals, grievances, disputes or complaints to ensure all regulatory guidelines are met. Interpret, analyze, and review all MA benefit offerings and their relevant language, corporate policies, administrative and operating procedures, information systems, and regulatory guidance to address a variety of issues which may not be clear or direct. Manage time to optimize and prioritize work to ensure goals (internal, regulatory, etc.) are met in a fluctuating environment. Use discretion to make judgment calls determining appropriate sources, directions, and parameters necessary to review and resolve issues in an extremely diverse, complex, and challenging business and regulatory environment. This can include interaction with a variety of internal and/or external contacts. Develop effective working relationships with staff at every level within BCBSKS, other Plans, CMS Caseworkers or Account Manager, relevant suppliers and contractors, providers, and/or members and their representatives to facilitate accurate and timely resolution of cases. Serve as a backup to the MA Customer Experience Representatives as business needs dictate. This involves researching, resolving, and responding to inquiries and correspondence via telephone, written and email communication. Inquiries may be regarding MA benefits, eligibility, coverage and plan changes, payments, claims, prior authorizations, appeals, and grievances. Complete special projects related to appeals, grievances or other CXR responsibilities. **What you\'ll need** Education High school diploma or equival nt required College or continuing education courses in communications and/or medical related fields preferred **Experience** Minimum 2 years\' experience customer service required Minimum 3 years\' experience MA or Medicaid Appeals and Grievances Required Minimum 2 years\' experience MA or other call center or Production-based Customer Service Experience Preferred Previous experience with Blue Plan preferred **Knowledge, Skills and Abilities** Ability to interact positively with internal and external customers while demonstrating empathy, adaptability, and listening skills. Ability to listen, talk type and perform research simultaneously using various research channels. Ability to apply excellent reasoning, analytical, and problem-solving skills, and sound judgment. Ability to conduct extensive research, provide analyses and solutions to unusual or recurring issues, at times using discretion. Ability to efficiently manage dissimilar issues, determine priorities and meet regulatory and/or company deadlines. Ability to demonstrate advanced human relations skills and communi