• Clinical Appeals Representative

    Adecco US, Inc. (Ontario, CA)


    Adecco Medical & Science is hiring a REMOTE Clinical Appeals Representative for a healthcare organization based in Ontario, CA!

     

    This is a 100% remote opportunity with occasional in-office visits to process mail at the Ontario location.

     

    Please read the details below and apply with a current resume for consideration.

    Position Details:

    • Type: Contract position

    • Schedule: Monday – Friday, 8:00 AM – 4:30 PM (training hours same as regular schedule)

    • Pay: $24 to $ 26.30/hour

    Key Responsibilities:

    • Serve as the point of contact for Health Plan member grievances and potential quality of care issues (PQIs)

    • Coordinate the intake and initial processing of member grievances and quality of care concerns from internal and external sources

    • Perform data entry, record requests, and follow-ups while maintaining required documentation in databases

    • Communicate with provider offices and other entities to ensure documentation is received on time

    • Manage turnaround times (TATs) within Health Plan timelines (ranging from 24 hours to 10 days, depending on request type)

    Qualifications:

    • High School Diploma or GED required

    • Strong organizational and communication skills

    • Prior healthcare or insurance experience preferred

     

    Why work for Adecco?

     

    • Excellent Weekly Pay

    • 401(k) Plan

    • Skills Training

    • Excellent Medical, Dental, and Vision Benefits

    **Pay Details:** $24.00 to $26.30 per hour

     

    Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.

     

    Equal Opportunity Employer/Veterans/Disabled

     

    To read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to https://uat.adecco.com/en-us/candidate-privacy

    The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable:

    + The California Fair Chance Act

    + Los Angeles City Fair Chance Ordinance

    + Los Angeles County Fair Chance Ordinance for Employers

    + San Francisco Fair Chance Ordinance

    **Massachusetts Candidates Only:** It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.