MPF Federal, LLC

Customer Service Representative – Appeals and Grievance

MPF Federal, LLC

full-time

Posted on:

Location Type: Remote

Location: United States

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Salary

💰 $15 - $18 per hour

About the role

  • Responsible for providing expertise or general support to teams in reviewing, researching and investigating, negotiating and resolving all types of appeals and grievances.
  • Communicates with appropriate internal parties regarding appeals and grievance issues, implications, and decisions.
  • May also need to analyze and identify trends for all appeals and grievances.
  • May research and resolve written complex or multi-issue provider complaints submitted by physicians/providers.

Requirements

  • High School Diploma / GED (or higher).
  • 2+ years of healthcare claims benefits experience including researching claim denials.
  • 1+ years of experience in a customer service environment.
  • 1+ years Claims Appeal experience.
  • Basic Proficiency in Microsoft Excel and Word (ability to create, edit, save, and send).
  • Knowledge of TRICARE or Medicare (CMS) Policy and Processes.
  • Ability to ask probing questions to identify underlying issues.
  • Ability to think analytically.
  • Time management and organizational skills.
  • Issue resolution skills as well as the ability to interact with internal and external customers.
Benefits
  • medical benefits
  • PTO
  • holiday pay
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
healthcare claims benefitsresearching claim denialsclaims appealMicrosoft ExcelMicrosoft WordTRICARE policyMedicare policy
Soft Skills
analytical thinkingtime managementorganizational skillsissue resolutioncustomer servicecommunication
Certifications
High School DiplomaGED