SCA Appeals Representative I
Remote · from United States
Core
Reviewing, analyzing, and processing non-complex pre and post service grievances and appeals requests from members, providers, and regulatory bodies related to clinical and non-clinical services.
Role type
Senior IC appeals representative (healthcare claims)
Builds
Approved or summarized grievance and appeal decisions routed to nursing/medical staff
Domain
Healthcare administration / Federal programs
Required skills
Grievances and appeals processing, Claims processing, Customer service, Regulatory compliance analysis, Medical records analysis, Business writing
Preferred skills
Medical coding, Medical terminology, Provider networks knowledge, Medical management process understanding, Internal local technology proficiency