Grievances & Appeals Expedited Case Rep
Core
Review and evaluate expedited Medicaid and AIP (dual) appeals cases by analyzing clinical documentation to determine if an appeal is warranted.
Role type
Senior IC case representative (healthcare appeals)
Builds
Expedited Medicaid and AIP appeal resolutions for members and providers
Domain
Healthcare / Insurance / Medicaid
Required skills
Clinical documentation review, case urgency assessment, outbound calling, queue management, process adaptation, Microsoft Office proficiency, high-volume workload management
Preferred skills
Inbound call center experience, Grievances and Appeals experience, medical authorization processing, Medicare/Medicaid knowledge, medical terminology, bilingual (English/Spanish)
Technologies
Microsoft Word, Excel, Outlook, Teams
Responsibilities
Review and evaluate several expedited Medicaid and AIP cases per hour; Manage cases from assignment to resolution; Assess case urgency and process cases in chronological order; Make outbound calls to deliver outcomes or request documentation; Monitor multiple workstreams and adapt to process changes; Communicate gaps or issues and seek guidance
Seniority
Entry-level to Mid-level, hands-on IC