Appeals And Grievance Specialist
 TEKsystems | |
$20.00 - $23.00 / hr
| |
life insurance, sick time, 401(k), retirement plan
| |
 United States, Wisconsin, Appleton | |
 Mar 29, 2025 | |
|
Location:
* Appleton, WI * Hybrid Schedule (2-3 days on-site) *Description* * Fully reviews all appeals and grievances assigned, to determine appropriate supporting documentation needed to address the issue being appealed. * Compile supporting documentation for appeal process. Resolve any discrepancies in information with internal departments or providers as necessary. * Communicate with members regarding status of appeals that have been submitted. Perform necessary outreach as appropriate to gather any missing information needed to continue with their appeal or grievance. Educate members on the appeal or grievance process to mitigate future potential issues or concerns which may arise. * Collaborate with the legal department regarding hearing requests before an Administrative Law Judge (ALJ). Prepare and submit required documentation for hearing. * Prepare letters or written summaries to members, providers and third parties outlining benefit determination, clearly articulating the rationale in conformance with the member benefit document and applicable state and/or federal regulations * Other duties and responsibilities as assigned. *Additional Skills & Qualifications* * A minimum of two years of experience working for a health insurance carrier or similar environment is required, preferably in the fields of appeals and grievance, customer service, claims, utilization management or compliance. * Prior experience working with state and federal regulations such as Medicare, ERISA, Office of Commissioner of Insurance regulations, and similar regulations is preferred. * HS diploma * Associate degree preferred *Pay and Benefits* The pay range for this position is $20.00 - $23.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: * Medical, dental & vision * Critical Illness, Accident, and Hospital * 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available * Life Insurance (Voluntary Life & AD&D for the employee and dependents) * Short and long-term disability * Health Spending Account (HSA) * Transportation benefits * Employee Assistance Program * Time Off/Leave (PTO, Vacation or Sick Leave) *Workplace Type* This is a fully onsite position in Appleton,WI. *Application Deadline* This position is anticipated to close on Apr 11, 2025. About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. | |