Job Details

Job Title: REMOTE Grievances and Appeals Specialist

About Kyyba:

Founded in 1998 and headquartered in Farmington Hills, MI, Kyyba has a global presence delivering high-quality resources and top-notch recruiting services, enabling businesses to effectively respond to organizational changes and technological advances.

At Kyyba, the overall well-being of our employees and their families is important to us. We are proud of our work culture which embodies our core values; incorporating value, passion, excellence, empowerment, and happiness creates a vibrant and productive atmosphere. We empower our employees with the resources, incentives, and flexibility that they need to support a healthy, balanced, and fulfilling career by providing many valuable benefits and a balanced compensation structure combined with career development.

Position Details:

Title: Grievances and Appeals Specialist

Location: REMOTE (Detroit, Michigan)

Duration: 12 Months (possible extension)

Dept.: MA Grievances and Appeals

Position: Grievances and Appeals Specialist

Work Location: Fully Remote (No onsite requirement)

Dept.: MA Grievances and Appeals

Will this position be required to work onsite for any reason at any time? No, fully remote

Please no candidates from FL, AZ, NY, NJ, MO, MA, MD, CA

Engagement Description

Process appeals and grievances, analyze, research, and provide comprehensive responses in accordance with established regulatory and accreditation guidelines. Contact customers to gather information and communicate disposition of case. Conduct pertinent research in order to evaluate, respond to, and finalize case. Familiar with standard concepts, practices, and procedures for analyzing, interpreting data and applying contract and regulatory provisions. High School Diploma or GED required. Bachelor's Degree in English, Communications or related field preferred. Two (2) years customer service experience required. Two (2) years health insurance experience and familiarity with health insurance state and federal regulations preferred. Strong project management skills preferred.

Top 3 Required Skills/Experience

Experience handling a large load of work in a fast-paced environment and have computer skills!

Insurance, Medicare/CMS knowledge

Customer Service Experience

Required Skills/Experience The rest of the required skills/experience. Include:

Writing Letters

Analytical thinker

Research Skills

Multi-task

Preferred Skills/Experience Optional but preferred skills/experience. Include:

Grievance and Appeals experience.

Degree in Healthcare/computer skills

Experience in analyzing a claim

Experience in classification between a grievance/appeal/organizational determination.

Letter writing

Basic computer skills. How to save a PDF, how to navigate excel, learning new systems

Education/Certifications Include:

Healthcare, English

Location: Remote

Page Range Where Required (currently California, Colorado, New York, Washington)

Disclaimer:

Kyyba is an Equal Opportunity Employer.

Kyyba does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other basis covered by appropriate law. Minorities / Females / Protected Veterans / Individuals with Disabilities are encouraged to apply. All employment is decided on the basis of qualifications, merit, and business need.

It is the policy of Kyyba to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact Kyyba at 248-###-####.