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About the Role
Elderplan and HomeFirst are expanding services to meet patient and member needs, offering high-quality healthcare plans designed to help people live independently. This role offers an opportunity to positively impact members' lives.
Responsibilities
- Investigate and respond to written or verbal appeals and grievances from members and providers.
- Ensure compliance with Contract Benefits and CMS and DOH regulations.
- Determine the appropriate type of service, appeal, or grievance.
- Investigate and respond within established time guidelines.
- Present cases for review.
- Document all relevant information.
Requirements
- 2 years of prior related experience.
- Proficiency in MS Word and Excel.
- Excellent written and verbal communication skills.
- Strong attention to detail.
- Ability to set priorities appropriately.
- Ability to meet strict deadlines.
- Ability to manage multiple tasks simultaneously.
Skills
- MS Word
- MS Excel
- Written communication
- Verbal communication
- Attention to detail
- Prioritization
- Time management
- Multitasking
Experience Level
- 2 years
Education Level
- Associate's degree or equivalent preferred
Salary/Compensations
- USD $50,000.00/Yr.
- USD $55,000.00/Yr.
Benefits
- Tuition Reimbursement for all full and part-time staff
- Generous paid time off, including your birthday
- Affordable and comprehensive medical, dental and vision coverage for employee and family members
- Two retirement plans: 403(b) AND Employer Paid Pension
- Flexible spending
- Qualified employer under the Federal Government’s Paid Student Loan Forgiveness Program (PSLF)
About the Company
- MJHS is a supportive community committed to excellence, respect, and providing high-quality, personalized health care services.
- We foster collaboration, celebrate achievements, and promote fairness for all.
- Our contributions are recognized with comprehensive compensation and benefits, career development, and the opportunity for a healthy work-life balance, advancement within our organization and the fulfillment of having a lasting impact on the communities we serve.