Job description
Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together we will achieve our mission to enhance the health and well-being of the people and communities we serve.
At Independence, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
The Medicare Appeals Specialist investigates Medicare Advantage member appeals and grievances in accordance with established policies and CMS regulations. The Appeals Specialist is also responsible for the preparation case files for both clinical and administrative review.
Duties include, but are not limited to:
- Researches the history relevant to the case, including the member’s enrollment and eligibility status, benefit plan and circumstances surrounding denial of services or rejection of claims.
- Communicates with members or representatives verbally and in writing according to unit policy and within the established timeframes.
- Documents all communication in relevant systems used within the department.
- Communicates effectively and professionally with internal and external resources to coordinate and investigate information as it relates to the member’s appeal.
- Ensures case file documents are filed and secured according to unit guidelines and are submitted timely for Q/A purposes.
- Organizes case files for external review per regulatory guidelines and performs other duties as assigned
- Well qualified applicants will possess an associate degree and/or three years related experience with customer service and/or complaints handling.
- A working knowledge of Medicare and Medicare Supplemental products is also preferred.
- In addition, the qualified applicant would demonstrate their ability to handle complex member issues, exceptional writing, editing and proofreading skills, excellent customer service, organizational, verbal and written communication skills.
- A working knowledge of Word and Excel is a plus.
Hybrid of Choice:
Independence has implemented a “Hybrid of Choice” model which provides our associates with the flexibility to choose whether to work remotely, work in the office every day, or work in the office on certain days at their discretion. However, management may require our associates to work from Independence’s physical office locations on certain occasions. This role is designated as a role that fits into the “Hybrid of Choice” model. While associates may work remotely, the work must be performed in the Tri-State Area of Delaware, New Jersey or Pennsylvania.
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