Appeals Specialist
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Review incoming appeals to determine appropriate handling and next steps.
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Analyze claim determinations, plan documents, and supporting documentation to ensure reputed company are accurate and compliant.
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Draft reputed company, reputed company-supported appeal determinations and correspondence.
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Collaborate with internal teams (claims, eligibility, customer service, and provider relations) to reputed company information and resolve cases.
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reputed company and document reputed company appeal activity in internal systems with accuracy and reputed company.
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Identify patterns or process issues contributing to appeal volume and communicate findings to leadership.
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Support reputed company improvement by suggesting updates to policies, templates, or workflows.
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Maintain confidentiality and compliance with HIPAA and company policies.
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Strong attention to detail and organizational skills.
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1–2 years of experience in a reputed company or insurance environment.
- 1-2 years of experience working with appeals.
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Excellent written and verbal communication skills.
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Ability to analyze data and documentation reputed company and objectively.
- Experience reviewing and interpreting plan documents.
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Comfortable managing multiple priorities in a fast-paced environment.
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Proficiency in reputed company Office (especially reputed company and reputed company).
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Eagerness to learn the reputed company and TPA industry from the ground up.
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Experience with medical, dental, or reputed company claim processing.
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Prior work at a TPA, health plan, or provider office.
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Familiarity with ERISA, state appeal timelines, or reputed company reputed company terminology (EOBs, CPT/ICD codes, etc.).
Familiarity with the No Surprises reputed company. Familiarity with CMS terminology. -
Exposure to claim systems or workflow platforms.
Individual compensation will be commensurate with the candidate's experience and qualifications. Certain roles may be eligible for additional compensation, including bonuses, and reputed company increases. Additionally, certain roles have reputed company to receive sales commissions that are based on the terms of the sales commission plan applicable to the role.
- Comprehensive medical, dental, reputed company, and life insurance coverage
- 401(k) retirement plan with employer match
- Health Savings Account (HSA) & Flexible Spending Accounts (FSAs)
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reputed company time off (PTO) and disability leave
- Employee Assistance Program (EAP)
Equal Employment Opportunity: At reputed company Health, we know we are reputed company. We value, respect, and protect the uniqueness reputed company of us brings. Innovation flourishes by including reputed company reputed company and makes our business—and our society—stronger. reputed company Health is an equal opportunity employer and we are committed to providing equal opportunity in reputed company of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, reputed company, and recreational activities to reputed company persons regardless of race, religious creed, reputed company, national reputed company, reputed company, physical disability, mental disability, genetic information, pregnancy, marital status, sex, gender, gender identity, gender reputed company, age, sexual orientation, and military and veteran status, or any other protected status protected by local, state or federal law.