Your Future Evolves HereEvolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones.Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business.Join Evolent for the mission. Stay for the culture.What You’ll Be Doing:The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures while complying with timeliness guidelines. Our team values collaboration, continuous learning, and a customer-centric approach, ensuring that every team member contributes to providing better health outcomes for the Clients and Members we serve.Collaboration Opportunities:
The coordinators are assigned to one of 3 teams, with varied job duties depending on level of training. They interact with lead coordinators for assignments and questions, managers for oversight, guidance, and workday matters, and other coordinators for collaboration, questions, and camaraderie. The Appeals teamwork strategies and opportunities for collaboration include all-team and individual team meetings, Teams chats, Holiday contests with prizes, and monthly communication on team metrics and accomplishments.
What You Will Be Doing:
Receive inbound calls, faxes, emails, and mail to initiate an appeal request utilizing multiple software applications.
Make outbound calls when necessary to obtain additional information pertaining to the research of an appeal.
Collect, organize, and track information received from a variety of resources to facilitate and expedite the processing of appeals.
Generate acknowledgement letters for delegated appeals in accordance with regulatory standards.
Initiate, research and refer delegated appeals to the clinical teams.
Utilize multiple internal and external computer applications and programs.
Meet established productivity, quality standards and timeliness.
Qualifications Required and Preferred:
2 years of experience minimum in processing appeals – Preferred.
3 years of experience within a health plan, managed care organization or third-party administrator – Preferred.
Understanding of appeals process and utilization management – Preferred.
Working knowledge of regulatory and accreditation requirements – Preferred.
Excellent verbal and written communication skills – Required.
Technical Requirements:We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status. If you need reasonable accommodation to access the information provided on this website, please contact [email protected] for further assistance.The expected base salary/wage range for this position is $22/hr. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts.