Medical Claims

Description:

Amerit Consulting is seeking a Medical Claims/ Appeals Specialist for a 6-month+ temp-to-hire opportunity. This is an entry-level position within the Appeals Department where the specialist will review, analyze, and process non-complex pre-service and post-service grievances and appeals from various customer types. The role requires understanding of medical claims, quality of care issues, and familiarity with the grievances and appeals process, with specific attention to external accreditation and regulatory requirements.

The specialist will work remotely during the training period (5-6 weeks), and after training, candidates may flex their work hours. Once converted to full-time, they must be willing to work onsite per the hybrid requirements for FTE associates.

Key Responsibilities:

• Review and process non-complex grievances and appeals in accordance with regulatory requirements and internal policies

• Conduct research and analyze grievance and appeal issues, reviewing claims and medical records to either approve or route for further review

• Follow department guidelines and tools to ensure compliance with accreditation and regulatory standards

• Write clear, understandable written responses to customers regarding grievance and appeal determinations

• The role excludes any medical management review activities requiring the interpretation of clinical information

Qualifications:

• High school diploma or GED

• Up to 2 years’ experience in grievances and appeals, claims, or customer service

• Familiarity with medical terminology and coding

• Strong business writing proficiency

• Understanding of the medical management process and provider networks

• Preferred: Experience in letter writing, claims, and appeals

Salary & Benefits:

• $20/hr on W2

• Opportunity for temp-to-hire conversion

• Remote during training with possibility of onsite work post-conversion