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Medical Claims Appeals Specialist

Remote:

Full Remote

Experience:

Mid-level (2-5 years)

Work from:

United States

Offer summary

Qualifications:

High School diploma or equivalent, 3 years of experience in medical claims, Proficient in Excel and Word, Ability to analyze claim situations.

Key responsabilities:

Log and track all received appeals
Compose appeal response letters when necessary

Allied Benefit Systems, LLC Unicorn https://www.alliedbenefit.com/

501 - 1000 Employees

See all jobs

Job description

APPEALS SPECIALIST

Position Summary

The Appeals Specialist will be responsible for the organization and completion of all claim appeals received in the Appeal Department.

Essential Functions

Logging/tracking all appeals received
Reviewing appeal and supporting documentation
Reviewing Summary Plan Documents to determine validity of appeal
Composing appeal response letters when necessary
Communicating with other departments and clients when necessary
Documenting the QicLink system and database with appeal status and outcome
Emailing claims examiners and other units when necessary
Prioritize incoming referrals to complete all tasks timely
Performs other related duties as assigned

EDUCATION

High School diploma or equivalent required

Experience And Skills

3 years or more of comprehensive experience with the billing of or otherwise handling of medical, dental and vision claims required.
Applicant should be proficient in the use of the Excel and Word programs
Experience with or ability to learn Microsoft Access
Be able to communicate effectively both orally and by email
Applicant must have the ability to analyze claim situations, take appropriate actions and be great with communication and documentation.
Applicant must have a history of excellent quality results and the desire to take on a new challenge if currently employed at Allied.

POSITION COMPETENCIES

Communication
Customer Focus
Accountability
Functional/Technical Job Skills

PHYSICAL DEMANDS

This is a standard desk role – long periods of sitting and working on a computer are required.

WORK ENVIRONMENT

Remote

The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.