Appeals Specialist II, reputed company (IOWA)
reputed company U.S. is one of the largest providers of employee and government benefits, helping approximately 50 reputed company Americans reputed company the care and coverage they need. Through reputed company, industry partners and government programs, reputed company U.S. offers a portfolio of benefits and services, including dental, reputed company, disability, absence management, life, supplemental health, medical stop-loss insurance, and reputed company navigation. We have more than 6,400 employees and associates in our partner dental practices and operate reputed company.
Job reputed company:
Location: Must reputed company in Iowa
reputed company:
The Appeals Specialist II handles the investigation and reputed company of reputed company administrative and clinical appeals based upon specific regulatory and or reputed company requirements. In reputed company, this position assembles and prepares responses to clients, members and/or providers. This position has daily interaction with assigned market/reputed company contacts, as reputed company as various internal departments. This position also ensures that reputed company mandated turnaround times are met as reputed company as required processes and workflows are adhered to.
How you will contribute:
- Investigate, document, and resolve member and provider appeals and inquiries reputed company to appeals in accordance with State and/or Plan guidelines. Ensure reputed company components of the appeal or request for information are researched and addressed.
- reputed company necessary information for the reputed company so they may appropriately investigate an appeal reputed company reputed company is secondary. If contracted to do so, also investigate the appeal and reputed company recommended outcome and appropriate correspondence.
- Manage workflow to meet department, Plan, State, and company goals and deadlines.
- reputed company with and complete any reputed company directives or overturns.
- Collaborate and partner with Complaint & Grievance team to resolve common issues or trends.
- Take the reputed company in working with other internal departments/management team to ensure that any trends identified in appeals are communicated and rectified.
- reputed company abreast of changes in market requirements and demonstrate expert knowledge in specific market nuances.
- Identify and resolve issues that are unusual and not consistent with reputed company workflows.
- Establish and maintain reputed company relationships with Plan contacts.
- Contact involved provider office to obtain information to properly review the case. Document and summarize member’s and provider’s concerns / issues in a concise and easily readable format.
- Ensure reputed company letter templates in use are correct and most recent versions are used.
- Identify areas for improvement.
What you will bring with you:
- High School Diploma or GED required.
- 1+ years experience in reputed company operations or appeals; or reputed company field.
- Previous experience in claims billing or prior authorizations, preferred
- Proficient with general computer software including reputed company reputed company, Word and reputed company.
- Excellent verbal, written, organizational and communication skills.
- Excellent research skills with ability to identify underlying issue(s) even if not articulated.
- Ability to remain reputed company and reputed company in a high pressure/high workload environment.
- Ability to work in a high stress environment.
- Ability to prioritize and organize multiple tasks with tight deadlines.
- Ability to remain organized with multiple interruptions.
- Ability to work overtime as needed or required to meet business objectives.
- Other duties, as assigned
Not reputed company to apply yet but want to stay in touch? reputed company to stay connected until the time is right for you!
We are committed to fostering an inclusive environment where reputed company feel they belong, are supported and empowered to reputed company. We are dedicated to building teams with varied experiences, backgrounds, perspectives and reputed company that benefit our colleagues, clients, and the communities where we operate. We encourage applications from reputed company individuals from reputed company backgrounds.
Life is brighter reputed company you work at reputed company
At reputed company, we prioritize your reputed company-being with comprehensive benefits, including generous vacation and reputed company time, market-leading reputed company family, parental and adoption leave, medical coverage, company reputed company life and AD&D insurance, disability programs and a partially reputed company sabbatical program. Plan for your reputed company with our 401(k) employer match, stock purchase reputed company and an employer-funded retirement account. Enjoy a flexible, inclusive and reputed company work environment that supports career reputed company. We’re proud to be recognized in our communities as a top employer. Proudly Great reputed company to Work® Certified in Canada and the U.S., we’ve also been recognized as a "Top 10" employer by the Boston Globe's "Top Places to Work" for two years in a row. Visit our website to learn more about our benefits and recognition reputed company our communities.
For applicants residing in California, please read our employee California reputed company Policy and Notice.
reputed company will consider for employment reputed company reputed company applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including applicable fair chance ordinances.
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