Ascendo Resources Hiring for Medical Appeals Representative Job at Remote Full Time

The Appeals Rep is responsible for reviewing and processing medical policies, grievances, and denials of medical claims. Provides professional customer service to insureds, agents, and accounts.

*Start date for this position: September 19th, 2022

• Review claims and determine appropriate actions: pay, request additional information, or deny benefits based on the type of coverage, policy provisions and exclusions as defined in the insurance certificate, including endorsement(s) and master policy.

• Ensures that all required documentation for claim(s) has been submitted and verified.

• Enters current claim information into the computer system and verifies that existing information related to the claim and the insured is accurate.

• Communicates with insureds, agents, outside vendors, medical providers and accounts verbally and in writing to gather or provide information about claims.

• Identifies potential workflow improvements and impediments.

• Analyzes information and makes payment or adjustments as needed.

• Maintains an understanding of related state laws, anti-fraud compliance requirements, claim processes, fair claim practice and company guidelines.

• Meets or exceeds quality and production standards and maintains all claims within pre-determined service level standards.

“Ascendo is a certified minority owned staffing firm, we welcome and celebrate diversity. Ascendo is an Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, retaliation, parental status, military service or any non-merit factor.”

Job Type: Full-time

Pay: Up to $16.41 per hour

Benefits:

• Dental insurance
• Health insurance
• Paid time off

Schedule:

• 8 hour shift
• Monday to Friday

Work Location: Remote