Job Description
We are seeking a detail-oriented Appeals Coordinator to manage the formal grievance and appeals process for a leading insurance provider. This role acts as a critical link between members, healthcare providers, and the clinical review team. You will be responsible for investigating denied claims, ensuring regulatory compliance, and facilitating fair resolutions within strict timelines. This is an ideal position for a professional who enjoys investigative work, analytical writing, and navigating complex healthcare regulations.
salary: $22 - $24 per hour
shift: First
work hours: 8 AM - 5 PM
education: High School
Responsibilities
- Review denied authorizations or claims to determine the basis of the appeal and identify missing clinical documentation.
- Ensure all cases meet CMS, state, and federal mandates, specifically adhering to strict turnaround time (TAT) requirements.
- Collaborate with Medical Directors and clinical staff to facilitate secondary reviews and interpret medical necessity criteria.
- Draft formal resolution letters that clearly articulate complex clinical and administrative decisions to members and providers.
- Maintain meticulous records within the grievance and appeals database to ensure audit readiness at all times.
Skills
- Insurance Claim Processing
- Multi-tasking
- Problem Solving
- Data Entry
Qualifications
- Years of experience: 1 year
- Experience level: Entry Level
Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad.
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.
At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.
Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).
This posting is open for thirty (30) days.
Job Tags
Hourly pay, Permanent employment, Temporary work, Work experience placement, Shift work