Job Description

OVERVIEW:

Our client, a US Fortune 50 organization and a leading provider of Healthcare and Health Insurance services , seeks an accomplished Medical Appeals Specialist .

IMPORTANT NOTES: REMOTE / WORK-FROM-HOME RELATED:

• This will be a Remote role.
• Estimated dates: 05/18/2026 start; likely to extend and/or convert temp-hire after the temp work is completed
• Equipment's will be provided.
• MUST have high-speed wired Internet connection. Wi-Fi / Wireless connections are not allowed.
• MUST have a reliable home-office environment.
• Training Shift Hours: 40 hours per week | 08:00am to 4:30pm (Eastern Time).
• Training will be 5-6 weeks.
• POST training, the candidates may choose to flex start time of 6:00 AM to 10:00 AM (Eastern Time).
• These are not HYBRID requirements while working temp. However, if/when they convert temp-hire, they must be willing to work onsite depending on what the HYBRID requirements for FTE associates are at the time of conversion (usually 1-3 days per week)
• No overtime, weekends, or on-call requirements

Client will be considering candidates MUST sit within 50 miles of below location (Please apply accordingly):

• New York, NY
• Iselin, NJ
• Morristown, NJ
• Lake Success, NY
• Ashburn, VA
• Seattle, WA

Responsibilities:

• This is an entry level position in the NGS Appeals Department that reviews, analyzes and processes non-complex pre-service and post service grievances and appeals requests from customer types (i.e. member, provider, regulatory and third party) and multiple products (Part A & B) related to clinical and non-clinical services, quality of service, and quality of care issues to include executive and regulatory grievances.
• Reviews, analyzes and processes non-complex grievances and appeals in accordance with external accreditation and regulatory requirements, internal policies and claims events requiring adaptation of written response in clear, understandable language.
• Utilizes guidelines and review tools to conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize and route to nursing and/or medical staff for review.
• The grievance and appeal work are subject to applicable accreditation and regulatory standards and requirements.
• As such, the analyst will strictly follow department guidelines and tools to conduct their reviews.
• Analyzes and renders determinations on assigned non-complex grievance and appeal issues and completion of the respective written communication documents to convey the determination.
• Responsibilities exclude conducting any utilization or medical management review activities which require the interpretation of clinical information.
• The analyst may serve as a liaison between grievances & appeals and /or medical management, legal, and/or service operations and other internal departments.

Required Qualifications:

• Must have High School Diploma or GED.
• Must have 3-4 years’ experience working with Medical Claims, grievances and appeals, Medicare, Part A OR PART B.
• Familiarity with medical terminology, demonstrated business writing proficiency.
• Must have strong understanding of provider networks, the medical management process , claims processing .
• Must be proficient handling high volume inbound calls .
• Must have background in following up with insurance providers .

I'd love to talk to you if you think this position is right up your alley, and assure prompt communication, whichever direction. If you're looking for rewarding employment and a company that puts its employees first, we'd like to work with you.

Recruiter Contact Info

Jatin Rattan

E-mail: jatin.rattan@ameritconsulting.com

I'd love to talk to you if you think this position is right up your alley, and assure prompt communication, whichever direction. If you're looking for rewarding employment and a company that puts its employees first, we'd like to work with you.

Company Overview:

Amerit Consulting is an extremely fast-growing staffing and consulting firm. Amerit Consulting was founded in 2002 to provide consulting, temporary staffing, direct hire, and payrolling services to Fortune 500 companies nationally; as well as small to mid-sized organizations on a local & regional level. Currently, Amerit has over 2,000 employees in 47 states. We develop and implement solutions that help our clients operate more efficiently, deliver greater customer satisfaction, and see a positive impact on their bottom line. We create value by bringing together the right people to achieve results. Our clients and employees say they choose to work with Amerit because of how we work with them - with service that exceeds their expectations and a personal commitment to their success. Our deep expertise in human capital management has fueled our expansion into direct hire placements, temporary staffing, contract placements, and additional staffing and consulting services that propel our clients’ businesses forward.

Amerit Consulting provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. Applicants, with criminal histories, are considered in a manner that is consistent with local, state and federal laws.

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