Reconsideration Analyst III (Part C)

Job Posting

Please make sure your application is complete, including your education, employment history, and any other applicable sections. Initial screening is based on the minimum requirements as defined in the job posting, such as education, experience, licenses, and certifications. Your experience should also address the knowledge, skills and abilities needed for the role. Incomplete applications will not be considered.

This position is located Remote United States.

This position requires working weekends, and rotating holidays as needed.

Please note the start date is on or after July 6, 2026.

Position Purpose

Makes second level non-medical appeal decisions. This may include review of appeal cases dismissed by the level 1 contractor or Expedited appeals.

Essential Responsibilities

• Writes a non-medical reconsideration decision that is clear and supports the determination
• Ensures that all appeal issues raised by the party (e.g., enrollee, representative, or non-contract provider) have been
• Provides a fair and impartial decision based on current evidence, regulations, policies, and
• Ensures all documents are releasable and do not violate any Privacy Act
• Organizes documents by dates of service relevant to the charges, research denials and regulations used and ensure that any overpayment calculation is correct.

Minimum Qualifications

Education

• High School Diploma or equivalent

Experience

• Three (3) years of general office experience
• College education or technical training in administration, business, or related areas may be substituted for experience on a year per year (Education requirements may be satisfied by full-time education or the prorated part-time equivalent.)
• Two (2) years high volume of customer calls, appeals, or billing
• Medicare Part C related appeals activities, preferred

Benefits

• Medical, dental, vision, life, accidental death and dismemberment, and short and long-term disability insurance
• Section 125 plan
• 401K
• Competitive salary
• License/credentials reimbursement
• Tuition Reimbursement

EOE Vet/Disability

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

TMF Health Quality Institute