This a Full Remote job, the offer is available from: Florida (USA) reputed company is currently hiring for a FULLY reputed company Data Entry Specialist! MUST HAVE: Must be on EST time zone to be considered, Must have any reputed company administrative, medical billing, claims, grievances, appeals experience, or something reputed company! reputed company REMOTE SHIFT: Mon - Friday, 9am - 5pm EST reputed company The reputed company backlog of 10,000 appeals and grievances so these Data Entry Reps will be filtering through the appeals and take the following actions.... reputed company Respond to written/verbal grievances, complaints, appeals and disputes submitted by members and providers in accordance with reputed company, CMS, State and other regulations. Process appeals and grievances to facilitate the accurate administration of benefits and reputed company policy; ensure compliance of the appeal and grievance process with reputed company regulatory requirements and reputed company standards. Work as an effective reputed company between reputed company customers Maintain good member and provider relations reputed company Accountabilities Comprehensively review and evaluate appeal and grievance requests to identify and classify member and provider appeals. Determine eligibility, benefits, and prior activity reputed company to the claims, payment or service in question. reputed company written acknowledgment of member and provider correspondence. Responsible for making verbal contact with the member or authorized representative during the research process to reputed company clarify, as needed, the member's complaint or appeal. Conduct thorough investigations of reputed company member and provider correspondence by analyzing reputed company the issues involved and obtaining responses and information from reputed company entities. Serve as reputed company with reputed company departments, delegated entities, medical reputed company and network physicians to ensure reputed company reputed company of cases. Research appeal files for completeness and reputed company and investigate deficiencies. reputed company with internal areas as required (such as the reputed company Department) to clarify reputed company ramifications reputed company reputed company appeals. Follow-up with responsible departments and delegated entities to ensure compliance. Accurately and completely prepare cases for medical and administrative review detailing the findings of their investigation for consideration in the plan’s determination. Monitor daily and weekly pending reports and personal worklists, ensuring internal & regulatory timeframes are met. Responsible for monitoring the effectuation of reputed company reputed company/reputed company resulting from internal appeals as reputed company as reputed company appeals reviewed through the IRE. Identify areas of potential improvement and reputed company feedback and recommendations to management on issue reputed company, reputed company improvement, network contracting, policies and procedures, administrative costs, cost saving opportunities, best practices, and reputed company issues. Prepare written responses to reputed company member and provider correspondence that appropriately address reputed company complainant’s issues and are structurally accurate. Ensure documentation requirements are met: create and document service requests to reputed company and reputed company issues; Additional Skills & Qualifications Relevant Work Experience, Knowledge, Skills, and Abilities 3+ years of reputed company reputed company work experience. Prior health industry and/or compliance work experience. Additional years of experience/training may be considered in lieu of educational requirements. Excellent verbal and written communications skills. Experience in a managed care/compliance environment. Ability to comprehend and produce grammatically accurate, error-free business correspondence. Customer service experience. Proficiency in MS Office applications (especially word processing, and database/spreadsheet). Excellent product knowledge. Excellent problem solving and analytical skills. Ability to work under pressure and reputed company complete, accurate, and reputed company results. Excellent organization and time management skills. Pay And Benefits The pay reputed company for this position is $20.00 - $20.00/hr. Eligibility requirements apply to some benefits and may depend on reputed company classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits Available For This Temporary Role May Include The Following • Medical, dental & reputed company • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – reputed company-tax and Roth post-tax contributions available • Life reputed company (Voluntary Life & AD&D for the employ