The Redetermination (Appeals) Specialist supports the Medicare Appeals team by performing non-medical reviews, preparing redetermination letters, and ensuring timely and accurate processing. This role requires strong organizational skills, attention to detail, and the ability to work with reports, documentation, and multiple software tools in a fast-paced environment.

Key Responsibilities

• 50% – Perform non-medical reviews and process redetermination letters, ensuring accuracy and compliance with established timelines.
• 30% – Prepare unit reports, analyze and interpret workload data, and address processing issues using various software tools.
• 10% – Update letters, templates, and departmental documents as needed.
• 10% – Gather and prepare documentation for legal inquiries and administrative requests.

Education Requirements

• High School Diploma or equivalent required.
• Associate’s or Bachelor’s degree preferred.

Work Experience

• Minimum of 2 years of relevant experience in healthcare, insurance, or Medicare/Medicaid services.
• Customer service experience preferred.
• Medicare-specific experience preferred but not required; comprehensive training provided.

Skills & Abilities

• Proficiency with Microsoft Office (Word, Excel, Outlook).
• Strong organizational skills with excellent attention to detail.
• Effective written and verbal communication skills.
• Demonstrated ability to exercise sound judgment and handle confidential information.
• Strong spelling, grammar, and punctuation skills.

Work Environment

• Remote, work from home
• M-F, 40 hours a week

Benefits

• 401(k) & matching
• Dental insurance
• Vision insurance
• Health insurance
• Life insurance
• Paid Time Off (PTO)
• Paid Holidays