BedfordRecruiter Since 2001
the smart solution for Bedford jobs

Appeals Processing Senior Representative Bedford, TX

Company: 829 GulfQuest LP
Location: Bedford
Posted on: October 13, 2020

Job Description:

Essential Duties and Responsibilities: - Works closely with staff at all levels of Cigna-HealthSpring to investigate, document, and resolve complex complaints. - Conducts analysis, investigation and resolution of member appeals - Functions as the resource on contracted and non-contracted provider appeals. - Review, analysis and triage of all cases received via Call Tracker or in writing. - Prepares cases for second level appeals, QOC, fair hearing, or court preparation. - Responsible for determining the appropriate type of response to a requested appeal or complaint. - Must determine deadline dates on all cases and ensure they are met or exceeded. - Prepares all correspondence to gather and investigate a case. - Prepares a history of the investigation for each case. - Obtains clinical input as needed to resolve cases requiring medical input. - Refers cases to other departments to gather information to complete the investigation. - Independently makes decisions about the resolution of their assigned cases. - Produces all documentation to support the decision. - Documents the decision in a resolution letter to the appellant or grievant. - Ensures that overturns that require claims payment are processed with proof of payment placed in the file. - Maintains tracking and monitoring information on a database and software used in the department. - Provides tracking and trending reports to departmental leadership on the root causes of appeals and complaints and the high volume appellants. - Prepares cases for external review. - Responds to Expedited and Provider Claim appeals. - Keeps current with all requirements of STAR+PLUS plan appeals and complaints. - Provides training to peers as necessary Qualifications: - HS diploma or GED required. - At least 1+ years of appeals and grievance experience required. - Excellent written and verbal communication required. - Proficient level knowledge of Excel, Word, etc. - Prior healthcare experience highly preferred About Cigna Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with Cigna, youll enjoy meaningful career experiences that enrich peoples lives while working together to make the world a healthier place. What difference will you make? To see our culture in action, search #TeamCigna on Instagram. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: for support. Do not email for an update on your application or to provide your resume as you will not receive a response.

Keywords: 829 GulfQuest LP, Bedford , Appeals Processing Senior Representative Bedford, TX, Other , Bedford, Texas

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Other Jobs


Uber Eats: Deliver Food With Uber - Flexible Gig
Description: Deliver Food with Uber Flexible
Company: Uber Eats
Location: Wylie
Posted on: 10/25/2020

Truck Driver - Owner Operator - Average $140,000 to $170,000/Year
Description: Job Description Dillon Logistics is Seeking Owner Operators Average 140K- 170K per year 2,000 Sign-On Bonus Equipped with an elite driver force, we deliver exceptional, efficient, superior services (more...)
Company: Dillon Logistics - Owner Operators
Location: Wylie
Posted on: 10/25/2020

Flexible Hours - Lyft Driver
Description: What is Lyft 10 Lyft is a platform that connects drivers with individuals and organizations that need rides. 10 In addition to helping passengers get from A to B, in select markets drivers may also (more...)
Company: Lyft
Location: Wylie
Posted on: 10/25/2020


Certified Medical Assistant
Description: JOB SUMMARY The Certified Medical Assistant 1, under the direction of a physician, assists in the delivery of health care for patients. This position performs a wide variety of patient care activities (more...)
Company: Baylor Scott & White Health
Location: Wylie
Posted on: 10/25/2020

General Manager
Description: It's the dream job you never have to wake up from. At SONIC, you'll whistle while you work, gaining a sense of accomplishment along the way. You'll interact with fantastic people, earn great pay, sport (more...)
Company: Sonic
Location: Wylie
Posted on: 10/25/2020

CDL A Truck Driver Regional Solo or Team
Description: Regional CDL A Truck Driving Jobs for Solo or Teams We are hiring Class A CDL Truck Drivers for our Regional Lanes you can drive solo or team MVT is looking for Truck Drivers that have
Company: Mesilla Valley Transportation
Location: Wylie
Posted on: 10/25/2020

Lyft Driver
Description: What is Lyft 10 Lyft is a platform that connects drivers with individuals and organizations that need rides. 10 In addition to helping passengers get from A to B, in select markets drivers may also (more...)
Company: Lyft
Location: Wylie
Posted on: 10/25/2020

CDL A Dedicated Regional Truck Driver - Home Weekly + No-Touch
Description: Job DescriptionClass A Driver Needed for Home Weekly Regional Run Paper Transport PTI , has an exciting CDL-A truck driver opportunity for dedicated freight. Our CDL-A dedicated truck driving jobs offer (more...)
Company: Paper Transport - PTI
Location: Wylie
Posted on: 10/25/2020

Truck Driver CDL A
Description: Job Description: 10 10 CDL A Truck Drivers Needed We offer 100 paid health care insurance, great home time and more Call 866-214-5950 to speak with a recruiter
Company: YRC Freight
Location: Wylie
Posted on: 10/25/2020

Data Engineer - Senior Level
Description: Purpose of Job Data Engineer - Senior Level We are currently seeking a talented Data Engineer - Senior Level for our Plano, TX facility. Data Engineers deliver quality reporting and data intelligence (more...)
Company: USAA
Location: Wylie
Posted on: 10/25/2020

Log In or Create An Account

Get the latest Texas jobs by following @recnetTX on Twitter!

Bedford RSS job feeds