This role is for someone who knows how to untangle denied claims, follow the thread, and get to the real issue behind an appeal or grievance. If you’ve worked healthcare benefits and can investigate, document, and resolve complex complaints without needing your hand held, this job is built around that skill set.
About MPF Federal
MPF Federal supports government and healthcare-related operations by providing service teams that handle detailed, process-heavy work. This role focuses on researching and resolving appeals and grievances while collaborating with internal stakeholders as needed.
Schedule
Remote (United States)
Independent work with some coordination/support for others as needed
Pay: $15.00–$17.75/hour (varies based on SCA rates by county)
What You’ll Do
- Review, research, investigate, negotiate, and resolve appeals and grievances
- Communicate decisions, implications, and outcomes to appropriate internal teams
- Analyze appeals and grievances for patterns and trends
- Research and resolve written, complex, multi-issue provider complaints from physicians/providers
- Work independently in situations where procedures may not be fully established
- Serve as a resource to others and help coordinate activities when needed
What You Need
- High School Diploma / GED (or higher)
- 2+ years of healthcare claims benefits experience, including researching claim denials
- 1+ year of customer service experience
- 1+ year of claims appeal experience
- Basic proficiency in Microsoft Excel and Word (create, edit, save, send)
- Ability to ask probing questions to uncover root issues
- Strong analytical thinking, time management, and organization
- Solid issue resolution skills and comfort working with internal and external customers
- Knowledge of TRICARE or Medicare (CMS) policy and processes (preferred)
Benefits
- Medical benefits
- PTO
- Holiday pay
- Additional competitive benefits (varies by program)
If you’ve got the claims and appeals background and you’re ready for a role where independence matters, don’t wait around. These get filled fast once the right candidate shows up.
Bring the details, the patience, and the problem-solving mindset.
Happy Hunting,
~Two Chicks…