Remote Medicare Advantage Appeals and Grievances Specialist

The Medicare Advantage Appeals and Grievances Customer Experience Specialist provides a world class customer service experience through processing and resolution of Medicare Advantage (MA) member, member representative, or provider appeals and grievances. May also process and resolve member, representative, provider, and other Blue Plan inquiries.


“This position is eligible to work onsite, remote, or hybrid (9 or more days a month onsite) in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.”

o This role includes hours that can range from 8:00 a.m. to 8:00 p.m. and can include weekend hours from October 1 through March 31.
o The position will start approximately April 14, 2025



Why Join Us?
• Family Comes First: Total rewards package that promotes the idea of family first for all employees; including paid time off and family first leave.
• Professional Growth Opportunities: Advance your career with ongoing training and development programs both through our internal Blue University and external opportunities.
• Dynamic Work Environment: Collaborate with a team of passionate and driven individuals.
• Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
• Balance: paid vacation and sick leave with paid maternity and paternity available immediately upon hire

Compensation

$26.34- $32.93
Non-Exempt Grade 13
• Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.

Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.

What you’ll do

Responsibilities:   

• Create and compose correspondence in response to MA member, member representative or provider appeals and grievances cases to ensure all regulatory guidelines are met.
• Interpret, analyze, and review all MA benefit offerings and their relevant language, corporate policies, administrative and operating procedures, information systems, and regulatory guidance to address a variety of issues which may not be clear or direct.
• Manage time to optimize and prioritize work to ensure goals (internal, regulatory, etc.) are …