Employer Industry: Health Insurance

Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Flexible hybrid work environment with the option for remote work
- Engaging and supportive workplace culture recognized as a Healthiest Employer
- Involvement in meaningful work that impacts member and provider satisfaction
- Comprehensive training and continuing education in the fields of medicine and managed care
- Competitive pay based on experience and qualifications

What to Expect (Job Responsibilities):
- Utilize clinical acumen to research and resolve member and provider appeals, grievances, and corrected claims
- Maintain complete and accurate records in compliance with regulatory standards
- Respond to a high volume of health insurance appeal-related correspondence daily
- Analyze medical records to determine the appropriateness of appeal and grievance requests
- Collaborate with internal departments and external agencies to ensure effective resolution of inquiries

What is Required (Qualifications):
- Level I: 1 year of experience in clinical and health insurance or other healthcare-related fields
- Level II: 3 years of experience in clinical and health insurance, plus 1 year of managed care experience
- Level III: 5 years of experience in clinical and health insurance, plus 2 years of managed care experience
- Level IV: 8 years of experience in clinical and health insurance, plus 3 years of satisfactory job performance in managed care
- Active, current, and unrestricted license to practice in the State of Arizona or a compact state as a Registered Nurse, Physical Therapist, or Licensed Master Social Worker

How to Stand Out (Preferred Qualifications):
- Level I: 3 years of experience in clinical and health insurance or other healthcare-related fields
- Level II: 5 years of experience in clinical and health insurance, plus 2 years of managed care experience
- Level III: 7 years of experience in clinical and health insurance, plus 5 years of managed care experience
- Level IV: 9 years of experience in clinical and health insurance, plus 5 years of satisfactory job performance in managed care
- Bachelor's Degree in Nursing or related field of study

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