Sorry, this job is no longer accepting applications. See below for more jobs that match what you’re looking for!

Appeals Associate

Expired Job

Cigna Bedford , TX 76021

Posted 2 months ago

Job Summary:

Responsible for handling member and provider appeals/complaints involving medical necessity, retroactive authorizations, prescription drug coverage, and/or member eligibility. Responsible for tracking and reporting performance against HHSC guidelines. May complete intake, initialize the case for processing, and ensure cases are completed in a quality, organized, and timely fashion.

Essential Duties and Responsibilities:

  • Responsible for intake of appeals/complaint unit mail, sorting, and distributing within required timeframes.

  • Responsible for date stamping and properly identifying request type and region. Utilizes appropriate system to research required documentation for case work up.

  • Responsible for determining the appropriate type of response to a requested appeal or complaint.

  • Must determine deadline dates on all cases and ensure they are met or exceeded.

  • Contacts parties to obtain missing/outstanding information for processing and completion.

  • Prepares all correspondence to gather and investigate a case.

  • Obtains waivers of liability (WOL), authorization of representative (AOR), and medical records requests.

  • Refers cases to other departments to gather information to complete the investigation.

  • Maintains tracking and monitoring information on a database and software used in the department.

  • Provides tracking and trending reports to departmental leadership on the root causes of appeals and complaints and the high volume appellants.

  • Responds to Expedited and Provider Claim appeals.

  • Keeps current with all requirements of STAR PLUS plan appeals and complaints.

  • Provides training to peers as necessary in case handling.

  • Enters all job related activities in the applicable database

Knowledge, Skills, Abilities Required:

  • Comprehensive knowledge in STAR PLUS Appeals and Complaints and experience in managed care

  • Strong analytical skills, ability to formulate, write reports and professional correspondence

  • Knowledge of regulations and statutory language and interpretation

  • Understanding of the claims, membership and health services systems

  • Strong sense of customer service.

  • Excellent verbal and written communication skills.

  • Strong interpersonal skills including tact, diplomacy, and flexibility to work effectively with senior administration, staff and general public.


  • High School Diploma or Equivalent

  • Knowledge and Proficiency with Microsoft Office

  • Strong data entry skills

See if you are a match!

See how well your resume matches up to this job - upload your resume now.

Find your dream job anywhere
with the LiveCareer app.
Download the
LiveCareer app and find
your dream job anywhere

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
RLT Retail Sales Associate FT

2020 Companies

Posted Yesterday

VIEW JOBS 11/16/2018 12:00:00 AM 2019-02-14T00:00 Overview Full-Time Sales Associate We are seeking enthusiastic personalities, willing to learn and transform from a Sales Associate to a full-time (FT) Energy Pro! Promote a service that will never be obsolete. Bring your potential, and we will maximize it. As an Energy Pro, You Will: * Engage with Consumers about Reliant Electricity, Security, and Home Automation Solutions. * Advocate for Reliant Electricity, Security, and Home Automation Solutions within Your Community. * Learn How to Uncover Consumer Desires and Overcome Objections. * Foster Professional Relationships with Customers and Fellow Employees. * Welcome Customers and Politely Offer Solutions, as Needed. * Collaborate with Your Team to Accomplish Goals and Celebrate Success. What's in it For You? * Competitive Weekly Pay * Paid Training Course * Exciting, Fast-Paced Work Environment * Base + Uncapped Commission * Apparel and Equipment Provided * Great Locations Throughout Your Community * No Door-To-Door, Cold Calling, or Telemarketing * Current Sales Reps Earn an Average of $750/Week! * Career Growth and Advancement * Health Benefits and 401k CAREER OPPORTUNITY With 2020's rapid growth comes an exciting career path and professional development opportunities. We represent companies throughout the US across multiple industries affording our employees unlimited growth potential within the organization. 2020 trains its teams to succeed in any environment and equips them with the best technology and training to be flexible, engaging, and adept at solving problems. A typical career path starts here and progresses to Store Leader, Market Leader, and District/Regional Leader, with professional development through our advanced leadership training program for those that qualify. Your course is limitless! ABOUT RELIANT, BY NRG Reliant, by NRG is the leading integrated power company in the US, built on the strength of the nation's largest and most diverse competitive platform. A Fortune 200 company, NRG creates value through best in class operations, reliable and efficient electric generation, and a retail platform serving residential and commercial businesses. ABOUT 2020 COMPANIES For nearly 25 years, 2020 Companies has been the premier outsourced sales and marketing agencies in the US launching and advocating new products and brands, penetrating new consumer segments, and executing sales and marketing strategies. 2020 Companies recruits, hires, trains, and cultivates Sales Representatives, Brand Ambassadors, Merchandisers, and Casted-Talent, to tailor a full-package solution to clients wanting to grow their market share, build brand awareness, expand distribution channels, and connect people with consumers. 2020 is committed to inspiring our LEADERSHIP values for a far-reaching impact in the industry. CLICK "APPLY" NOW FOR IMMEDIATE CONSIDERATION #SalesAssociate #Sales #Retail #Job #Career Duties and Responsibilities * Sell products and services in a retail store, kiosk, and/or event environments * Maintain professional interaction with both customers and fellow employees * Meet or exceed personal sales goals on a monthly basis * Courteously welcome customers and offer assistance * Direct customers by escorting them to displays; assess needs and suggests products to fit those needs * Advise customers by providing information on products and services * Help customers make selections by building customer confidence * Accurately document and report sales * Contribute to team effort by accomplishing related results as needed * Responsible for accurately tracking and communicating all activity to Retail Operations * Ensure work station/kiosk is clean, well-organized, functional and presentable at all times * Responsible for submitting all paperwork completely and accurately Performance Measurements: * Regular and prompt attendance * Meet established monthly/weekly sales quota/goals * Customer/client satisfaction based on rejection percentage and substantiated complaints Qualifications: * High school diploma or equivalent required; Business degree preferred * Six (6) months prior sales, retail, telecom or marketing experience * Demonstrated knowledge of products and services * Excellent communications, presentation, interpersonal and problem-solving skills * Impeccable integrity and commitment to customer satisfaction * Ability to multi-task in a fast-paced, team environment * Ability to work flexible weekends including evenings, weekends and holidays * Ability to maintain customer confidentiality 2020 Companies Bedford TX

Appeals Associate

Expired Job