Top 14314 Next step systems limited Jobs

Appeals Specialist I (Remote)
CareFirst BlueCross BlueShield —Baltimore, MD
- $41,544 - $76,164 a year
- Full-time
- Remote
- Research
- Mid-level
- 3 years
- 401(k)
Quick Apply
8d
Investor Relations / Fundraising Lead (Remote | Confidential)
Noble Cortex —Remote
- Remote
- 6 years
- Mid-level
- Travel
- Paid training
- Health insurance
Case Research & Coordination Specialist - Human Services Program - Remote
The Workforce Group —Remote
- Remote
- Background check
- Spanish
- Pass drug screening
Quick Apply
Customer Care Associate
Health Advocate —Remote
- From $16.50 an hour
- Full-time
- Remote
- Medical office experience
- HIPAA
- Organizational skills
- Paid holidays
- Health insurance
Payment Integrity Analyst - Data Mining
Lyric —Remote
- $24.20 - $36.30 an hour
- Full-time
- Remote
- HIPAA
- Mid-level
- SQL
Consultant, Agentic Factory
Vista Equity Partners Management —Remote
- Full-time
- Remote
- Azure
- Computer Science
- Mid-level
14d
Faculty Assistant and Program Coordinator
Harvard University —Cambridge, MA
- Full-time
- Hybrid work
- Google Workspace
- Microsoft Outlook
- Customer service
- Travel reimbursement
- Commuter assistance
5G DevOps Engineer
Peraton —College Park, MD
- $104,000 - $166,000 a year
- Full-time
- Bachelor of Science
- System design
- Java
- Health savings account
- Paid holidays
Certified Registered Nurse Anesthetist (CRNA)- $100,000 Sign-on Bonus, Relo & Education Assistance
Advocate Aurora Health —Milwaukee, WI
- $251,680 - $328,640 a year
- 8 hour shift
- CPR Certification
- Nursing
- RN License
- Paid parental leave
- Relocation assistance
Quick Apply
Registered Paraplanner
Starboard Financial Group, Ameriprise Financial Services, LLC —Brookfield, WI
- $60,000 - $77,000 a year
- Part-time
- Background check
- Microsoft Outlook
- Mid-level
- Profit sharing
- Paid holidays
Quick Apply
9d
Registered Nurse
Total Health Care —Baltimore, MD
- $40.87 - $45.67 an hour
- Full-time
- CPR Certification
- Nursing
- RN License
Quick Apply
Operating Veterinarian, Emergency Medicine and Surgery
Animal Emergency Care —Bellingham, WA
- $171,890 - $221,906 a year
- Overtime
- Mid-level
- Surgery
- ER
- Health savings account
- AD&D insurance
Quick Apply
Certified Registered Nurse Anesthetist (CRNA)- $100,000 Sign-on Bonus, Relo & Education Assistance
Advocate Aurora Health —Chicago, IL
- $251,680 - $328,640 a year
- 8 hour shift
- CPR Certification
- Nursing
- RN License
- Paid parental leave
- Relocation assistance
Quick Apply
Senior Pre-Litigation Case Manager/Legal Assistant
Towey Law, PLLC —Buffalo, NY
- $25 - $27 an hour
- Full-time
- Mid-level
- 3 years
- Organizational skills
- Free parking
- Paid holidays
Quick Apply
General Superintendent
Prime Controls, LP —Lubbock, TX
- $79,736.86 - $96,027.18 a year
- Full-time
- OSHA
- Construction site
- 5 years
- Relocation assistance
- Health insurance
Quick Apply
8d
Bilingual Instructional Support Teacher
BrightBee —Chicago, IL
- $65,390 a year
- Full-time
- Background check
- Classroom
- Spanish
Quick Apply
CNC Machinist 4 - 5 Axis Mills and Lathe
Crane Aerospace & Electronics —Burbank, CA
- $34.00 - $46.50 an hour
- Overtime
- Background check
- Pass drug screening
- Mid-level
- Paid holidays
- Disability insurance
General Superintendent
Prime Controls, LP —Abilene, TX
- $79,736.86 - $96,027.18 a year
- Full-time
- OSHA
- Construction site
- 5 years
- Relocation assistance
- Health insurance
Quick Apply
8d
Licensed Veterinary Technician, Emergency Medicine and Surgery
Animal Emergency Care —Bellingham, WA
- $29.25 - $41.25 an hour
- Overtime
- 18 years or older
- Mid-level
- High school diploma or GED
- Continuing education credits
- Health savings account
Quick Apply
Wealth Planning Liaison
MMG Wealth Management —Grand Haven, MI
- $45,000 - $85,000 a year
- Multiple hires
- Background check
- Microsoft Excel
- Microsoft Outlook
- Relocation assistance
- Tuition reimbursement
Quick Apply
14d

I want to receive the latest job alert for next step systems limited

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

next step systems limited jobs near

Appeals Specialist I (Remote)

CareFirst BlueCross BlueShield -
Baltimore, MD

Quick Apply

Job Details

Full-time
$41,544 - $76,164 a year
8 days ago

Benefits

401(k)

Qualifications

Research
High school diploma or GED
Internal employee customer service
Grammar Experience
Medical terminology

Full Job Description

Resp & Qualifications

PURPOSE:
The Appeals Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, and determination of next steps for the following line of business: Commercial. The incumbent is responsible for collecting, organizing and tracking information to facilitate and expedite processing of appeals and/or grievances received from a variety of sources. We are looking for an experienced professional to work remotely from within the greater Baltimore metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities. The ideal candidate will have previous experience working with appeals and grievances in a healthcare payor organization.

ESSENTIAL FUNCTIONS:

Prioritize, research and analyze all pertinent information of an appeal and/or grievance request. Access the appropriate technology platform to implement accurate and timely entry of an appeal, grievance and/or reconsideration correspondence and updates the appropriate referral source communication system. Review appropriate benefits and processing guidelines. Submit cases to the nurse for research/decisions and claims department for adjustments and/or claim updates. Performs and manages general mail and/or printing duties and other needs as requested per the needs of the department.
Utilizes professional written and verbal communications to request additional documentation to assist in response of all appeals and/or grievances based on State and Federal requirements for all lines of business. Interacts regularly with and responds to internal and external stakeholders, without breaching confidentiality of medical information.
Assists Supervisor and Appeals Specialists II and III with unit projects and other duties related to the appeals, grievance and/or reconsideration processes. Communicates with Supervisor to offer feedback regarding continuous improvement of unit workflow and processes. Actively participates in monthly meetings and discussions regarding quality, appeal and/or grievance research, data entry and helps to resolve any issues regarding the appeal and/or grievance intake and entry/documentation process.

QUALIFICATIONS:

Education Level: High School Diploma or GED.

Experience: 3 years experience in settings such as managed care, health care or insurance payor environment.

Preferred Qualifications:

College Degree.
Knowledge of CareFirst systems, Member/Provider Service, Claims or Care Management experience.

Knowledge, Skills and Abilities (KSAs)

Knowledge and understanding of medical terminology.
Demonstrated problem solving and decision-making skills, including the ability to exercise good judgement.
Strong organizational and analytical skills.
Strong verbal and written communication skills using proper grammar and ensuring all correspondence is in line with departmental and reconsideration policies and procedures.
Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Salary Range: $41,544 - $76,164

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

#LI-SS1

Quick Apply

Refine Your Search

next step systems limited jobs

Appeals Specialist I (Remote)

Investor Relations / Fundraising Lead (Remote | Confidential)

Case Research & Coordination Specialist - Human Services Program - Remote

Customer Care Associate

Payment Integrity Analyst - Data Mining

Consultant, Agentic Factory

Faculty Assistant and Program Coordinator

5G DevOps Engineer

Certified Registered Nurse Anesthetist (CRNA)- $100,000 Sign-on Bonus, Relo & Education Assistance

Registered Paraplanner

Registered Nurse

Operating Veterinarian, Emergency Medicine and Surgery

Certified Registered Nurse Anesthetist (CRNA)- $100,000 Sign-on Bonus, Relo & Education Assistance

Senior Pre-Litigation Case Manager/Legal Assistant

General Superintendent

Bilingual Instructional Support Teacher

CNC Machinist 4 - 5 Axis Mills and Lathe

General Superintendent

Licensed Veterinary Technician, Emergency Medicine and Surgery

Wealth Planning Liaison

I want to receive the latest job alert for next step systems limited

Related Searches

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected