Our Client, a Medical Center company, is looking for a Member Appeals Specialist for their Charlestown, MA location.
 

Responsibilities:

Primary responsibilities would include triaging incoming appeals / grievances, categorizing them appropriately, assigning them to the team, making outbound calls when necessary. Also checking voicemails, responding to emails/ voicemails

The role we are looking to fill would be focused on handling standard member appeals for pre-service pharmacy coverage for non-Medicare products, the turnaround times for these appeals is calendar days (expedited turnaround time is hours, but we start with standard appeals). The job requires use of our Appeals and Grievances system called Jiva (WellSense UM and CM are also working in this system),

Case management of the appeal starting at assignment of the case from the AG Coordinator,

Evaluating timeliness of the appeal, eligibility of the member,

Issuing...