Fair Hearing Appeals Agent

1 week ago

Trenton, United States Conduent State Healthcare, LLC Full time

Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments - creating exceptional outcomes for our clients and the millions of people who count on them. You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day.

Fair Hearing Appeals Agent  


$18.50/ Hourly  


Onsite- Hamilton, NJ  


Full-time and Full Benefits  


 


 


Location and Schedule 


This position is on-site located in Hamilton, New Jersey, United States. 


Shift Work: 8:00am – 4:30pm EST, Monday through Friday. 


Overtime is available and may be required. 


 


Are you seeking an opportunity to make a real impact in a company that appreciates ideas and new ways of thinking??? 


?? 


Join the Conduent Customer Service Team? 


Come join us and grow with a team of people who will challenge and inspire you to be the best??? 


 


?Working for you? 


Enjoy a positive, employee-friendly culture while playing an important role in supporting our clients.? 


 


$18.50 per hour pay rate (bi-weekly pay)? 


Paid Training with Equipment provided. 


Full-time schedule (40 hrs. a week)? 


Career Growth Opportunities? 


PerkSpot- Employee discount program 


Full Benefit Options - From the start, our paid training program will teach you all the skills needed to allow you to become successful in your role. We also offer a full benefits package, so you’ll be able to thrive both personally and professionally.? 


 


 


Role Summary 


An experienced healthcare (Medicaid & CHIP) call-center based customer service representative to process requests for an appeal (Fair Hearings for Plan A and Grievances for Plans B, C, and D) in a timely and accurate manner. Applicants and beneficiaries requiring financial assistance for medical services may appeal Fair Hearing or Grievance decisions to which they were denied coverage, or their coverage was terminated. Our Appeals Counselors process these appeals from applicants and beneficiaries for referrals from the Division of Medical Assistance and Health Services (DMAHS) of New Jersey. 


  


Reports To 


This position reports to the Appeals Supervisor and the Appeals Manager. The Appeals Manager reports to the Director of the Conduent New Jersey Eligibility project. 


 


Principal Duties and Responsibilities 


Manage assigned caseload. 


Evaluate appeal requests by reviewing the case in its entirety. 


Collect additional information from clients via mail or phone as needed. 


Follow up and monitor the missing information for eligibility determination. 


Prepare responses to inquiries from state representatives about cases. 


Proactively take all necessary actions to move the application process forward. 


Keep state representatives, applicants and beneficiaries informed by communicating case progress. 


Develop and maintain professional and effective relationships with internal and external customers. 


Maintain accurate and detailed data on case status and requirements. 


Learn and maintain technical and program policy proficiency in the New Jersey Family Care rules/guidelines and other related program policies. 


Identify wasteful steps and improvements in a process. 


All other duties as assigned. 


  


Required Skills and Abilities: 


Demonstrate a serious commitment to accuracy and quality while meeting goals or deadlines. 


Strive for perfect attendance. 


Be trusted and dependable to handle a high level of responsibility. 


Be able to adapt to policy changes, learn new tasks and assimilate information quickly. 


Demonstrate a high level of professionalism and integrity. 


Be able to review financial records, such as income statements, prior tax returns, and profit & loss statements.  


Work in a team environment. 


Possess excellent problem-solving skills and the ability to prioritize responsibilities and independently follow through on tasks. 


Ability to communicate effectively, both verbal and written, with clients and colleagues. 


Proficiency with Microsoft Office Suite required, especially Excel. 


Possess solid organizational and time management skills. 


Proven ability to work productively in high-pressure environment. 


Capable of working independently with minimal supervision. 


  


Education and Typical Years Experience 


Two to five years’ experience in the determination of beneficiary eligibility for public assistance is desired.  
Spanish proficiency a plus. 


 


Pay Transparency Laws in some locations require disclosure of compensation and/or benefits-related information.  For this position, actual salaries will vary and may be above or below the range based on various factors including but not limited to location, experience, and performance. In addition to base pay, this position, based on business need, may be eligible for a bonus or incentive. In addition, Conduent provides a variety of benefits to employees including health insurance coverage, voluntary dental and vision programs, life and disability insurance, a retirement savings plan, paid holidays, and paid time off (PTO) or vacation and/or sick time. The pay for this role is $18.50 per hour. 
Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law.
People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the "Submit" button at the bottom of the form. For those using Google Chrome or Mozilla Firefox please download the form first: click here to access or download the form. You may also click here to access Conduent's ADAAA Accommodation Policy. At Conduent we value the health and safety of our associates, their families and our community. For US applicants while we DO NOT require vaccination for most of our jobs, we DO require that you provide us with your vaccination status, where legally permissible. Providing this information is a requirement of your employment at Conduent.

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