Member Appeals & Grievances Specialist (remote)

Member Appeals & Grievances Specialist

This is a remote position open to any qualified applicant that lives in the United States. We are seeking a dedicated Member Appeals & Grievance Specialist with a minimum of 2 years of experience to join our team. The ideal candidate will have strong technical skills in MS Excel, knowledge / navigation skills for Microsoft programs in a fast-paced, production-driven environment and dedication to attendance adherence. Absences will not be permitted during training-approximately 6 weeks. This is a work-from-home position Monday - Friday with hours from 8 am - 4 : 30 pm EST, and no travel is required. Candidate will also have the desire to further their abilities and knowledge of Medicaid medical insurance processes as they will be responsible for the research and resolution of Medicaid provider appeals that will involve research of member benefits, eligibility, provider contracts, billing and coding, Utilization Management and state Medicaid policies.

Qualifications / Skills Needed :

• Minimum of 2 years of Appeals and Grievance experience
• Minimum of 2 years of medical claims processing experience (Must be with a healthcare plan, not on behalf of provider or provider's office)
• At least 1 year of Medicaid insurance customer service or claims processing
• Medicaid / Medicare Insurance Customer Service with managed care plans or directly with CMS
• Billing and Coding-Medical Insurance Knowledge
• Knowledge of Member / Provider Appeals and Grievances, processes, resolutions, compliance
• TAT Self-resolved troubleshooting ability for various IT issues
• Knowledge of QNXT
• Knowledge of PEGA
• Knowledge of SharePoint
• Sense of urgency with production and responsiveness to email and MS Teams
• Ability to create and fax written communication in a professional manner including spelling and grammar.

Salary and Other Compensation :

Benefits : Cognizant offers the following benefits for this position, subject to applicable eligibility requirements :

Disclaimer : The hourly rate, other compensation, and benefits information is accurate as of the date of this posting. Cognizant reserves the right to modify this information at any time, subject to applicable law. Cognizant is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.