Appeals and Grievances I - Military Veterans

AppleOne is proud to present:
This Appeals and Grievance Supervisor Position Features:

• Competitive salary and benefits package.


• Overtime opportunity


• Hybrid schedule


• Great Pay to $68K

Appeals & Grievances Specialist I

Schedule: Rotating weekends and holidays; standard hours from 8 AM to 5 PM, with potential overtime during busy seasons (may require working until 6 or 7 PM as needed)

Position Overview:
We are seeking a dedicated and detail-oriented Appeals & Grievances Specialist I to join our team. The ideal candidate will have a strong background in managed care and a passion for advocating for patients' rights. This role is essential in ensuring that grievances are handled efficiently and in compliance with relevant regulations.

Key Responsibilities:
- Manage and resolve appeals and grievances in a timely manner.
- Communicate effectively with members, providers, and internal teams to gather necessary information.
- Interpret and apply regulations related to Medicare, Medi-Cal, and other state-sponsored programs.
- Maintain accurate records and documentation of all interactions and resolutions.
- Work collaboratively with team members to meet firm deadlines and improve processes.

Qualifications:
- Education: Associate's degree required; or 3+ years of experience in Appeals & Grievances with excellent writing skills in lieu of a degree.
- Experience:
- Minimum of 1 year of experience in grievances within a call center environment in managed care.
- At least 1 year of experience in managed care, specifically working with Medicare, Medi-Cal, and other state-sponsored programs.

Skills:
- Must be organized and detail-oriented.
- Ability to exercise strong independent judgment.
- Excellent conflict resolution and persuasion skills.
- Strong advocacy skills and a commitment to patient care.
- Ability to work under pressure and meet deadlines while maintaining attention to detail.

Join our growing team! Apply today!

#1031

EEO/AA Employer/Vet/Disabled.



The Know Your Rights poster is available here:

https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12.pdf



The pay transparency policy is available here:

https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf



For temporary assignments lasting 13 weeks or longer, the Company is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.



We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.



AppleOne participates in the E-Verify program in certain locations as required by law. Learn more about the E-Verify program.

https://e-verify.uscis.gov/web/media/resourcesContents/E-Verify_Participation_Poster_ES.pdf

Experienced (Non-Manager)