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Appeals Clerk, Start 7/22

4 months ago

Jenkins Township, United States MMC Group LP Full time
Job DescriptionJob Description

Location: Onsite for 3 months during training; afterward, the candidates will be remote.

Essential Job Duties:

  • Issue informal resolution based on review of an appeal case by obtaining information from various resources, including utilization of the Income Verification Tool/calculator
  • Analyze appeals data using federal and/or state laws and regulations along with technical direction, guidance, tools and standard operating procedures provided by unit or client
  • Contact the appellant for more information and to clarify questions
  • Find any errors during completion of template and correct errors to ensure timely processing Provide telephone outreach to the appellants to explain the results of the IR determination and respond to inquiries based on the standard procedure/process
  • Initiate and terminate pended benefits coverage to determine the appellant’s eligibility during the adjudication of the appeal.
  • Utilize the Marketplace Change Utility to update appellant applications using information and documentation collected during the appeal process.
  • Use specialized tools for complex effectuation scenarios to ensure proper allocation of subsidies.
  • Perform other functions as requested by management within scope of level or provide occasional support of lower level functions as business and volume needs require
  • Receive inbound calls, transferred from the Call Center, to schedule hearings for appellants/authorized representative who did not receive their desired outcome through the Informal Resolution Process.
  • Review appeals to verify that an Informal Resolution was issued and confirm that the appellant/authorized representative is dissatisfied with the informal resolution.
  • Review the appeal for Language Assistance and Accommodation requests to ensure the proper timeframe allotment for the hearing.
  • Complete an Urgency Determination Tool to determine scheduling priority.
  • Discuss appellant/authorized representative preferences regarding availability for a hearing.
  • Track available timeslots in which a hearing can be scheduled.
  • Provide the appellant/authorized representative with the date/time of their scheduled hearing, update scheduling information in EACMS, and issue a Notice of Hearing confirming the date/time of the scheduled hearing.
  • Other scheduling related duties as assigned.

Education and Experience Requirements

  • Associate's Degree from an accredited college or university or equivalent experience required Bachelor's Degree from an accredited college or university in business or related field preferred
  • At least two (2) years of related experience required
  • More than two (2) years of experience in healthcare or appeals preferred
  • Strong attention to details and proven ability to determine course of action based on multiple sources of information
  • Intermediate to advanced skill level in use of personal computer and related software applications such as Microsoft Word, Excel or Access
  • Ability to type 35 words per minute accurately
  • Excellent organizational, interpersonal, written and verbal communication skills
  • Ability to perform comfortably in a fast-paced, deadline-oriented work environment
  • Ability to successfully execute tasks simultaneously
  • Ability to work as a team member, as well as independently

Additional Information:


Office Address: 545 Keystone Ave, Jenkins Township, PA 18640; Candidates must live within 30 - 45 miles of the site; Closest counties to the site: Luzerne, Lackawanna, Wayne County, Monroe, & Wayne

Class start date: 07/22/24
Type: Temp to Perm (SCA)
Equipment: Will be provided, PC to be hardwired via Ethernet (No wifi) Internet requirements = upload and download speeds of at least 15 MBPS or higher


Training and Hours of Operation: 7:30 am to 4:00 pm EST

Must agree to mandatory attendance during the training period.

Job Types: Full-time, Contract

Pay: $18.38 - $22.61 per hour

For immediate review email sobrien@mmcgrp.com 

Company DescriptionThroughout the past 30 years plus, MMC, one of the most trusted names in workforce management services, has successfully delivered strategic solutions to large and small businesses in numerous industries.
We have built our reputation on partnering with our clients and candidates to achieve the desired results. Our recruiting professionals have extensive experience matching the right candidate, to the right client, for the right position. We provide the best opportunities to the most talented candidates in a multitude of industries.
MMC is a privately owned business with corporate headquarters in Irving, Texas. With 2,000+ employees, working in 40+ states, MMC is able to support all United States locations, and some international locations.
We appreciate your interest in reviewing this particular position and we encourage you to visit our website where you can always search and apply for opportunities at www.mmcgrp.com
Get started on your career journey today Apply to become a part of the MMC Team
We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.Company DescriptionThroughout the past 30 years plus, MMC, one of the most trusted names in workforce management services, has successfully delivered strategic solutions to large and small businesses in numerous industries.\r
We have built our reputation on partnering with our clients and candidates to achieve the desired results. Our recruiting professionals have extensive experience matching the right candidate, to the right client, for the right position. We provide the best opportunities to the most talented candidates in a multitude of industries.\r
MMC is a privately owned business with corporate headquarters in Irving, Texas. With 2,000+ employees, working in 40+ states, MMC is able to support all United States locations, and some international locations.\r
We appreciate your interest in reviewing this particular position and we encourage you to visit our website where you can always search and apply for opportunities at www.mmcgrp.com\r
Get started on your career journey today Apply to become a part of the MMC Team\r
We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.