Responsible for providing expertise or general support to teams in reviewing, researching and investigating, negotiating and resolving all types of appeals and grievances.
Communicates with appropriate internal parties regarding appeals and grievance issues, implications, and decisions.
May also need to analyze and identify trends for all appeals and grievances.
May research and resolve written complex or multi-issue provider complaints submitted by physicians/providers.
Extensive work experience within own function.
Work is frequently completed without established procedures.
Works independently.
May act as a resource for others.
May coordinate others' activities.

High School Diploma / GED (or higher).
2+ years of healthcare claims benefits experience including researching claim denials.
1+ years of experience in a customer service environment.
1+ years Claims Appeal experience.
Basic Proficiency in Microsoft Excel and Word (ability to create, edit, save, and send).
Knowledge of TRICARE or Medicare (CMS) Policy and Processes.
Ability to ask probing questions to identify underlying issues.
Ability to think analytically.
Time management and organizational skills.
Issue resolution skills as well as the ability to interact with internal and external customers.

MPF Federal is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status or on the basis of disability.
We offer a competitive compensation package including a competitive salary, medical benefits, PTO, holiday pay and more.

Customer Service Representative – Appeals and Grievance

Key skills