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Temporary Appeals Specialist

Portland, ME 04103

Employment Type: Part Time Industry: Office & Administrative Pay Rate: $27-$35 Specialty: Admin & Office Branch: Portland, ME Pay Type: Hour

Job Description

We are seeking a detail-oriented and knowledgeable Appeal Specialist to join our team, focusing on Medicare or US Family Health Plan (USFHP) appeals. This role ensures a comprehensive appeals management process by collaborating with Care Managers, Medical Directors, Compliance, and other internal and external partners.

Part time Monday - Friday 10 am - 2 pm.

Key Responsibilities:

For Medicare-Focused Specialists:

  • Research, process, and resolve Part C reconsiderations with 100% compliance.
  • Prepare for and participate in CMS, NCQA, and Health Plan audits.
  • Serve as a subject matter expert on Part C appeals and Medicare Managed Care Manuals.

For USFHP-Focused Specialists:

  • Research, process, and resolve appeals in accordance with TRICARE and NCQA guidelines.
  • Serve as a subject matter expert on TRICARE and USFHP manuals and member appeal benefits.

Job Requirements

 

  • Education: Bachelor’s degree or equivalent experience.
  • Experience:
    • 3+ years of managed care plan experience required.
    • Knowledge of Medicare Advantage (for Medicare Specialist) or TRICARE (for USFHP Specialist) appeals processes and regulations strongly preferred.
  • Strong attention to detail and regulatory compliance.

 

Additional Information

At HW Staffing Solutions we recognize the value of our employee associates as equally as our clients. We are passionate about people and improving the lives of every associate, we do this by connecting you with great companies and great opportunities. We celebrate our awesome diversity, believe that everyone has a unique talent, and appreciate the passion and perspectives that each of us bring to the table. Discover a new way to work together with a company that is focused on offering the best opportunities, benefits and career advancement in Accounting & Finance, Office & Administrative, Light Industrial, Professional & Technical, Call Center, Food Processing and Hospitality. HW Staffing Solutions is an Equal Employment Opportunity company.

Meet Your Recruiter

Sarah Gilliar
Staffing Specialist

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About Portland, ME

Discover exciting job opportunities in the vibrant Portland, Maine area! Known for its picturesque coastal charm, bustling Old Port district, and thriving arts scene, Portland is a city brimming with career possibilities and growth potential. From the renowned Portland Museum of Art to the eclectic array of seafood eateries along Commercial Street, there's no shortage of charm and culture to explore. Home to the Portland Symphony Orchestra, Portland Stage Company, and iconic Hadlock Field where fans cheer for the Portland Sea Dogs, this region offers a perfect blend of work and play. Dive into our job listings today and consider kickstarting your career in this enchanting city by the sea.