BusinessOperations - Intake Representative I - 700236

Candidate Requirements Education/Certification Required: High school diploma or equivalent Preferred: Licensure Required: Preferred: Years of experience required: Minimum of 2 years of experience in Grievance and Appeals operations within a healthcare or managed care environment, with a strong understanding of appeal intake, case processing, regulatory requirements, and applicable turnaround times. The team is responsible for monitoring and processing incoming emails and faxes, triaging Member and Provider Workbasket queues, identifying the appropriate case classification, and ensuring submissions are accurately documented and routed to the correct processing teams.

Position Purpose: The Intake Representative I enters specific data/information from physicians requests into a medical management authorization system, achieving required production quota/quality standards.

Education/Experience: High School diploma or equivalent; college course work preferred. Six months experience in a production/data entry environment performing alpha and numeric data entry in a healthcare related organization such as managed care, claims/billing, health insurance, customer service, call center, or claims office preferred.

License/Certification: Medically based trade school diploma/certification, desired.

" Validates patient and medical provider demographic information including correct selection of a medical provider by specialty for healthcare service.
" Determines whether patients are eligible to receive health care benefits under the insurance program by determining the patients status/eligibility the Primary Care Manager (doctor) type, and the appropriate referral/authorization path.
" Contacts medical provider offices by telephone, and makes confirmation calls to patients for all urgent requests. Uses sound judgment in making decisions in order to keep the referral/authorization process moving forward in accordance with contractual timeliness standards.
" Follows step-by-step instructions, including redirecting patients into the provider network for care, as required by contractual standards.
" Formulates brief sentences/paragraphs from referral/authorization orders and prepares correspondence in business letter format to provide clinical information to servicing providers.
" Generates letters and reviews to validate that they are going to the correct providers/patients, and that the provider/patient demographics and reason(s) for services to be rendered are correct.
" Accounts accurately for personal production via a production report that includes outcome data such as closed transactions, duplicative transactions and requests.
" Meets goals and produces results through tracking performance, improving work processes, and prioritizing work and tasks.
" Achieves successful solutions by reviewing situations and ensuring a full understanding before taking steps to resolve. Key components of this responsibility are objectively identifying problems, recognizing patterns, and determining solutions.
" Works as a team member; cooperates, assists and collaborates with co-workers to achieve goals and department success, and takes personal responsibility for achieving outstanding customer service.

EEO:

Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.

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Story Behind the Need
What is the purpose of this team? What is driving this need? (ex. Backfill for FTE or CW, new project, business growth) Describe the surrounding team (team culture, work environment, etc.) & key projects. Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative?		1. What is the purpose of this team? The Medicare Appeals Intake/Triage team serves as the initial point of entry for incoming appeals and related correspondence. The team is responsible for monitoring and processing incoming emails and faxes, triaging Member and Provider Workbasket queues, identifying the appropriate case classification, and ensuring submissions are accurately documented and routed to the correct processing teams. The team's primary objective is to support timely intake, prevent processing delays, and minimize compliance risks associated with late loads, late routes, and missed regulatory deadlines. 2. What is driving this need? The volume of incoming emails, faxes, and Member and Provider Workbasket submissions require consistent monitoring and timely action. Adding a dedicated Intake associate will strengthen coverage, improve workload distribution, and mitigate the risk of delayed processing and regulatory noncompliance. 3. Describe the surrounding team (team culture, work environment, etc.) and key projects. The Intake/Triage team operates in a fast-paced, deadline-driven environment where accuracy, accountability, collaboration, and effective prioritization are essential. Associates work closely with Appeals Research, Clinical, Escalations, and other operational teams to ensure cases are appropriately identified and routed. The team emphasizes cross-training, independent problem-solving, proactive communication, and shared responsibility for daily inventory. 4. Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative? This request addresses an immediate operational staffing need within Medicare Appeals Intake/Triage rather than a new project or broad hiring initiative. However, additional staffing needs may be identified as workload volumes, staffing capacity, and operational responsibilities continue to be evaluated.
Typical Day in the Role
Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD). What are performance expectations/metrics? What makes this role unique?			1. The associate will manage incoming emails and faxes, triage Member and Provider Workbasket queues, review submissions for accuracy, identify appeal classifications, and ensure timely routing to the appropriate teams. Daily responsibilities include prioritizing urgent requests, identifying duplicate submissions, maintaining accurate case documentation, and preventing processing delays. 2. Performance will be measured by daily productivity, accuracy of case classification and routing, timely processing of incoming submissions, and adherence to established turnaround times and quality standards. Associates are expected to independently manage assigned work, maintain minimal aging inventory, proactively communicate barriers, and consistently meet productivity and compliance expectations. 3. This role serves as a critical entry point for Medicare Appeals, directly influencing downstream processing efficiency, regulatory compliance, and the prevention of late loads and late routes. It requires strong attention to detail, sound judgment, multitasking, and the ability to navigate multiple systems while managing competing priorities in a high-volume environment.
Candidate Requirements
Education/Certification	Required: High school diploma or equivalent				Preferred:
Licensure	Required:				Preferred:
Years of experience required: Minimum of 2 years of experience in Grievance and Appeals operations within a healthcare or managed care environment, with a strong understanding of appeal intake, case processing, regulatory requirements, and applicable turnaround times. Disqualifiers: No Appeals or Grievance experience Additional qualities to look for: Strong Attention to Detail and Accuracy, Critical Thinking and Independent Decision-Making & Organization, Prioritization, and Adaptability
Top 3 must-have hard skills stack-ranked by importance			1	Medicare Appeals Intake & Triage Experience
			2	Email and Fax Management
			3	Data Entry and Documentation Accuracy
Candidate Review & Selection
Shortlisting process Candidate review & selection Interview information Onboard process and expectations			Projected Manager Candidate Review Date:			1-2 days post shortlisting
			Type of Interviews:			Teams on camera
			Required Testing or Assessment (by Vendor):			Basic computer skills test- intermediate plus
Next Steps
Do you have any upcoming PTO?			10/23/2026; 11/3-11/6; PTO 11/9-11/11
Colleagues to cc/delegate			N/A