Top 4651 Appeals Representative Jobs

Member Service Representative
Champion Health Plan/ Champion Payer Solutions —Long Beach, CA
- From $22 an hour
- Weekends as needed
- Spanish
- Microsoft Excel
- Microsoft Outlook
- Health insurance
- Dental insurance
Quick Apply
Denials and Appeals Representative
TeamHealth —Remote
- Full-time
- Computer literacy
- High school diploma or GED
- Organizational skills
- Paid holidays
- Health insurance
9d
Appeals Representative II
CorVel Corporation —Fort Worth, TX
- $20.08 - $30.06 an hour
- Full-time
- Remote
- HIPAA
- Mid-level
- High school diploma or GED
- Health savings account
- Disability insurance
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Billing/AR Representative - Remote
EYECARE SERVICES PARTNERS MANAGEMENT, LLC —Remote
- $19 - $25 an hour
- Full-time
- Remote
- Basic math
- Mid-level
- Windows
- Paid holidays
- Disability insurance
Quick Apply
Patient Account Representative - Remote
Med-Metrix —Remote
- Full-time
- Remote
- Customer service
- Basic math
- HIPAA
Appeals Representative
TeamHealth —Alcoa, TN
- Overtime
- Remote
- Research
- Mid-level
- High school diploma or GED
- Paid holidays
- Health insurance
9d
Appeals Specialist - Hospital Billing, Underpayments
Aspirion —Atlanta, GA
- $20 - $26 an hour
- Full-time
- Remote
- Research
- High school diploma or GED
- Bachelor's degree
- Work from home
Quick Apply
Call Center Remote Customer Service Representative
D&A CONSULTING SERVICE LLC —Virginia
- $17.00 - $18.50 an hour
- Full-time
- Remote
- Background check
- 18 years or older
- Spanish
- Paid training
- Paid time off
Quick Apply
Customer Service Representative
Firstsource Healthcare —Remote
- $15 an hour
- 8 hour shift
- Remote
- Computer literacy
- Writing skills
- Typing
- Dental insurance
- Work from home
Remote Healthcare Customer Service Representative
Conduent Commercial Solutions, LLC —Remote
- $16 an hour
- Email
- Remote
- Background check
- Microsoft Outlook
- Computer literacy
- Paid training
- Paid holidays
Call Center Remote Customer Service Representative
VIMO INC —Atlanta, GA
- $17.00 - $18.50 an hour
- Full-time
- Remote
- Background check
- 18 years or older
- Spanish
- Paid training
- Paid time off
Quick Apply
Managed Care Appeals Analyst
Elevate Patient Financial Solutions —Remote
- $23.00 - $28.28 an hour
- Full-time
- Remote
- Microsoft Word
- Surgery
- Writing skills
- Paid holidays
- Health insurance
Quick Apply
Denials Representative
TeamHealth —Remote
- Overtime
- Remote
- Microsoft Word
- Microsoft Outlook
- HIPAA
- Paid holidays
- Health insurance
9d
Client Service Representative
Firstsource Healthcare —Remote
- $15 an hour
- 8 hour shift
- Remote
- Computer literacy
- Writing skills
- Typing
- Dental insurance
- Work from home
Sr. Collections Representative
Quest Diagnostics —Lewisville, TX
- From $21.42 an hour
- Full-time
- Remote
- 18 years or older
- Research
- High school diploma or GED
- Employee stock purchase plan
- Disability insurance
Quick Apply
Patient Account Representative
PRN Physical Therapy —Remote
- $18 - $20 an hour
- Full-time
- Remote
- Mid-level
- High school diploma or GED
- Medical terminology
- Loan repayment program
- Health insurance
Quick Apply
Appeals Professional III (Weekend Work) (Part C)
TMF Health Quality Institute —Remote
- Weekends as needed
- Remote
- Writing skills
- Research
- Mid-level
- 401(k)
- Tuition reimbursement
(REMOTE) Appeals and Grievance Representative
Widescope Consulting and Contracting Services LLC —Powder Springs, GA
- $17.75 an hour
- Urgently hiring
- Remote
- Microsoft Excel
- Customer service
- Research
- Dental insurance
- Vision insurance
Medicaid Account Resolution Specialist - Digitech - Remote
Sarnova —Remote
- Full-time
- Remote
- Microsoft Outlook
- Computer literacy
- High school diploma or GED
- 401(k)
Quick Apply
Food Sales Representative
Amlat —Belleville, WI
- $38,000 - $50,000 a year
- Part-time
- Hybrid work
- Up to 50% travel
- Mid-level
- Driver's License
Quick Apply

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Member Service Representative

Champion Health Plan/ Champion Payer Solutions
Long Beach, CA

Quick Apply

Job Details

Full-time
From $22 an hour

Benefits

Health insurance
Dental insurance
401(k)
Paid time off
Vision insurance
Flexible schedule

Qualifications

Spanish
Customer communication
Teamwork
Customer retention
Managed care
Managed care organization experience
Call center experience
HIPAA
English
Vietnamese
High school diploma or GED
Medical terminology

Full Job Description

SCOPE OF ROLE

The Member Service Representative (MSR) serves as the first point of contact for customers, providers, and advocates, ensuring exceptional customer experiences through accurate and helpful communication. This role involves handling incoming calls from Medicare Advantage members, assisting with benefit inquiries, referrals, claims, and guiding them to community resources as needed. The ideal candidate will be bilingual, proficient in medical terminology, and knowledgeable in CMS, Medicare, and HIPAA regulations. Strong proficiency in Microsoft Applications and a commitment to delivering top-tier service are essential.

ROLE RESPONSIBILITIES

The Member Service Representative job description is intended to point out major responsibilities within the role, but it is not limited to these functions:

KEY RESPONSIBILITIES % OF TIME

 Serve as the primary point of contact for customers, providers, and advocates, handling calls with professionalism and courtesy.

 Provide clear, concise, and accurate information to ensure customers fully understand their benefits, referrals, claims, and available resources.

 Ensure prompt and efficient service by answering all incoming calls within the

department’s established time frame.

 Escalate complex issues to management or relevant departments as necessary to

ensure customer concerns are thoroughly addressed.

 Collaborate with internal teams to resolve problems and enhance overall customer

satisfaction.

 Accurately document customer interactions, including actions taken, resolutions

provided, and any follow-up required.

 Adhere to department policies and HIPAA regulations to maintain confidentiality and

security of member information.

 Manage complaints, grievances, and appeals efficiently according to department

protocols.

 Assist in onboarding and training new staff, sharing knowledge and best practices.

 Complete required training promptly to stay current with procedures, systems, and

regulations.

 Consistently meet or exceed standards for quality, productivity, and adherence to

schedules.

 Participate in outbound call campaigns for welcome calls, enrollment verification calls, appointment scheduling,

retention efforts, and other health-related programs.

 Contribute to policy and procedure development related to customer experience.

 Stay updated on CMS, Medicare, and HIPAA regulations to ensure compliance and

provide accurate information.

 Utilize medical terminology and healthcare knowledge to assist members with inquiries.

 Adapt to changes in shifts, responsibilities, and operational needs as required.

 Facilitate member requests for provider changes, transportation, and other assistance.

 Maintain a positive attitude and practice excellent customer service principles.

 Perform other duties as assigned to contribute to the team and department’s success

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

 High School diploma or GED required.

 Associate degree (AA) degree (preferred).

 Minimum (2) or more years of direct customer service EXPERIENCE

 Knowledge of Medi-Cal, Medicare Managed Care Plans.

 Medical front office experience preferred.

PROFESSIONAL COMPETENCIES

 Strong communication skills (verbal and written).

 Highly organized with the ability to prioritize work to meet deadlines.

 Strong adaptability and openness to change.

 Knowledge of HIPAA regulations with a commitment to data privacy.

 Strategic skills in problem-solving, critical thinking, and innovation.

 Ability to collaborate effectively with business partners throughout the organization.

 Experience assisting members with Medicare Advantage or HMO, including referrals and authorizations.

 Outbound/inbound call center experience with a focus on problem-solving and escalation.

 Bilingual in English/Spanish or Vietnamese/English required.

 Proficiency in Microsoft Applications (Word, Excel, Outlook).

 Ability to multitask and prioritize tasks effectively.

 Flexibility to work varying shifts, including evenings and weekends.

LICENSURES AND CERTIFICATIONS

No licensures or certifications are required.

WORK ENVIRONMENT and ESSENTIAL PHYSICAL FUNCITONS:

Work Environment:

 Must be available for scheduling 7 days a week, including evenings, overnights, weekends, and holidays.

 Shifts may change based on operational needs; flexibility is essential.

Essential Physical Functions:

 Ability to work onsite in an open office setting, primarily sitting at a desk and working on a computer.

 Regularly required to talk, hear, stand, walk, sit, and use hands to handle or feel objects and controls.

 Frequently lifts/moves up to 10 pounds. Specific vision abilities include close vision and the ability to adjust focus.

EEO/AFFIRMATIVE ACTION STATEMENT

As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse group of employees committed to meeting the needs of Champion Payer Solutions/ Champion Health Plan, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

Job Type: Full-time

Pay: From $22.00 per hour

Benefits:

401(k)
Dental insurance
Flexible schedule
Health insurance
Paid time off
Vision insurance

Experience:

Managed care: 2 years (Required)

Language:

Spanish (Preferred)
Vietnamese (Preferred)

Ability to Commute:

Long Beach, CA 90815 (Required)

Ability to Relocate:

Long Beach, CA 90815: Relocate before starting work (Preferred)

Work Location: In person

Quick Apply

Refine Your Search

Appeals Representative jobs

Member Service Representative

Denials and Appeals Representative

Appeals Representative II

Billing/AR Representative - Remote

Patient Account Representative - Remote

Appeals Representative

Appeals Specialist - Hospital Billing, Underpayments

Call Center Remote Customer Service Representative

Customer Service Representative

Remote Healthcare Customer Service Representative

Call Center Remote Customer Service Representative

Managed Care Appeals Analyst

Denials Representative

Client Service Representative

Sr. Collections Representative

Patient Account Representative

Appeals Professional III (Weekend Work) (Part C)

(REMOTE) Appeals and Grievance Representative

Medicaid Account Resolution Specialist - Digitech - Remote

Food Sales Representative

I want to receive the latest job alert for Appeals Representative

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