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Appeals Specialist; Disputes
Job in
Los Angeles, Los Angeles County, California, 90079, USA
Listed on 2026-10-04
Listing for:
TMF Health Quality Institute
Full Time, Part Time
position Listed on 2026-10-04
Job specializations:
-
Administrative/Clerical
Business Administration, Healthcare Administration
Job Description & How to Apply Below
* This position is located Remote, Anywhere US
* * Due to being a federal contractor, you may be subject to obtaining and maintaining a public trust security clearance from the federal government.
* Position
Purpose:
Researches and responds to inquiries from providers, suppliers, beneficiaries, health plans, or others involved in the appeals/dispute process. May conduct phone calls with appellants for the purpose of scheduling phone discussions with the company decision maker.
- Provides customer service and researches and responds to inquiries received by phone, fax, mail, or email timely and accurately.
- Interprets requests and determines appropriate response or course of action to bring to resolution with minimal assistance.
- Conducts research using online federal regulations, reviews contract policy and guidelines to complete an accurate and well-supported decision and/or response.
- Screens receipts to determine the issue addressed in the correspondence and address timely which may involve forwarding cases to the appropriate person or entity timely.
- Logs receipts and enters into database.
- Trends receipts/issues and schedules coordination meetings as required.
- High School Diploma or equivalent
- Three (3) years of general office experience
- College education or technical training in administration, business, or related areas may be substituted for experience on a year per year basis. (Education requirements may be satisfied by full-time education or the prorated part-time equivalent.)
- One (1) year of Medicare Qualified Independent Contractor appeals or Veterans Affairs (VA) experience OR One (1) year of professional business writing experience in the healthcare, customer service or legal industries
- Reside in US for last three (3) of five (5) years (Per Contract Requirement)
C2C offers an excellent benefits package, including:
- Medical, dental, vision, life, accidental death and dismemberment, and short and long-term disability insurance
- Section 125 plan
- 401K
- Tuition Reimbursement
EOE Vet/Disability
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.
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