PR:$19/hr -$20/hr

About the Role:

• We are looking for a dedicated individual to join our team at  Phoenix, AZ office as a Case Processor.
• The primary responsibility of this role will be processing A&G cases, as well as handling mail duties.

Responsibilities:

• Review and resolve member and provider complaints in accordance with CMS standards
• Research and resolve appeals, disputes, grievances, and complaints from client members, providers, and outside agencies
• Review claims appeals and grievances using support systems to determine outcomes
• Request and review medical records, notes, and bills to formulate conclusions
• Contact members/providers through written and verbal communication
• Prepare appeal summaries, correspondence, and document findings
• Compose all correspondence accurately and in accordance with regulatory requirements 
• Research claims processing guidelines, provider contracts, fee schedules, and system configurations
• Resolve and prepare responses to provider reconsideration requests and requests for claim adjustments

Education Qualification:

• High School Diploma or equivalency

Required Skills: 

• Minimum 2 years of operational managed care experience
• Health claims processing background
• Familiarity with claims denials and appeals processing
• Strong verbal and written communication skills