Associate Specialist, Appeals & Grievances - Florida - Remote
Posted 2025-08-23
Remote, USA
Full Time
Immediate Start
<p><strong>JOB DESCRIPTION</strong></p>
<p><strong>*** Candidates must be based in Florida. ******</strong></p>
<p><strong>Job Summary</strong></p>
<p>Responsible for reviewing and resolving member & provider complaints and communicating resolution to members (or authorized) representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid.</p>
<p> </p>
<p><strong>KNOWLEDGE/SKILLS/ABILITIES</strong></p>
<ul>
<li>Enters denials and requests for appeal into information system and prepares documentation for further review.</li>
<li>Research issues utilizing systems and other available resources.</li>
<li>Assures timeliness and appropriateness of appeals according to state and federal and Molina Healthcare guidelines.</li>
<li>Requests and obtains medical records, notes, and/or detailed bills as appropriate to assist with research.</li>
<li>Determines appropriate language for letters and prepare responses to appeals and grievances.</li>
<li>Elevates appropriate appeals to the Appeals Specialist.</li>
<li>Generates and mails denial letters.</li>
<li>Assists with interdepartmental issues to help coordinate problem solving in an efficient and timely manner.</li>
<li>Creates and/or maintains statistics and reporting.</li>
<li>Works with provider & member services to resolve balance bill issues and other member/provider complaints. </li>
</ul>
<p> </p>
<p><strong>JOB QUALIFICATIONS</strong></p>
<p><strong>REQUIRED EDUCATION:</strong></p>
<p>High School Diploma or equivalency</p>
<p><strong>REQUIRED EXPERIENCE:</strong></p>
<ul>
<li>1 year of Molina experience, health claims experience, OR one year of customer service/provider service experience in a managed care or healthcare environment.</li>
<li>Strong verbal and written communication skills.</li>
</ul>
<p> </p>
<p> </p>
<p>To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.</p>
<p>Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.</p>
<p><strong>*** Candidates must be based in Florida. ******</strong></p>
<p><strong>Job Summary</strong></p>
<p>Responsible for reviewing and resolving member & provider complaints and communicating resolution to members (or authorized) representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid.</p>
<p> </p>
<p><strong>KNOWLEDGE/SKILLS/ABILITIES</strong></p>
<ul>
<li>Enters denials and requests for appeal into information system and prepares documentation for further review.</li>
<li>Research issues utilizing systems and other available resources.</li>
<li>Assures timeliness and appropriateness of appeals according to state and federal and Molina Healthcare guidelines.</li>
<li>Requests and obtains medical records, notes, and/or detailed bills as appropriate to assist with research.</li>
<li>Determines appropriate language for letters and prepare responses to appeals and grievances.</li>
<li>Elevates appropriate appeals to the Appeals Specialist.</li>
<li>Generates and mails denial letters.</li>
<li>Assists with interdepartmental issues to help coordinate problem solving in an efficient and timely manner.</li>
<li>Creates and/or maintains statistics and reporting.</li>
<li>Works with provider & member services to resolve balance bill issues and other member/provider complaints. </li>
</ul>
<p> </p>
<p><strong>JOB QUALIFICATIONS</strong></p>
<p><strong>REQUIRED EDUCATION:</strong></p>
<p>High School Diploma or equivalency</p>
<p><strong>REQUIRED EXPERIENCE:</strong></p>
<ul>
<li>1 year of Molina experience, health claims experience, OR one year of customer service/provider service experience in a managed care or healthcare environment.</li>
<li>Strong verbal and written communication skills.</li>
</ul>
<p> </p>
<p> </p>
<p>To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.</p>
<p>Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.</p>