**Please make sure your application is complete, including your education, employment history, and any other applicable sections. Initial screening is based on the minimum requirements as defined in the job posting, such as education, experience, licenses, and certifications. Your experience should also address the knowledge, skills and abilities needed for the role. Incomplete applications will not be considered.**
*This position is located Remote United States*
*This position requires working weekends, and rotating holidays as needed *
*Please note the start date is on or after July 6, 2026*
Position Purpose:
Monitors the contractor’s interactions with and support of reconsideration decisions rendered to the higher-level appeal authority
Essential Responsibilities:
- Assists in reviewing Administrative Law Judge (ALJ) Remand Orders along with their associated case files and determines the appropriate steps necessary to resolve the issues.
- Assists in performing data analysis on cases returned to higher-level appeal authority and documents the percentage of cases affirmed verses overturned and the reasons for cases that are overturned.
- Assists in developing a formal document that includes findings from data analysis and provides recommendations as to how guidelines, policy and coverage decisions could be strengthened or changed to reduce the number of appeals cases overturned at the ALJ level.
- Assists in tracking and monitoring requests and ensures their timely return to the appropriate higher-level appeal authority
- Assists in contacting the higher-level appeal authority field office immediately for cases that are not within the contract’s jurisdiction or for cases already sent.
Minimum Qualifications
Education
- High School Diploma or equivalent
Experience
- Three (3) years of general office experience
- College education or technical training in analytics, administration, healthcare, or related areas may be substituted for experience on a year per year basis. (Education requirements may be satisfied by full-time education or the prorated part-time equivalent.)
- One (1) years Medicare appeals
- Medicare Part C related appeals activities, preferred
- Resided in the United States for a minimum of three (3) years out of the last five (5) years? (Per Contract Requirement)
Benefits
C2C offers an excellent benefits package, including:
- Medical, dental, vision, life, accidental death and dismemberment, and short and long-term disability insurance
- Section 125 plan
- 401K
- Competitive salary
- License/credentials reimbursement
- Tuition Reimbursement
EOE Vet/Disability
