Appeals Support Specialist

National African-American Insurance Association (NAAIA); Remote; EUR 37.000 - 52.000; Vollzeit

Zusammenfassung

A leading insurance organization in Germany is seeking a candidate for member appeals management. The role involves investigating and resolving inquiries while ensuring that all appeal components are addressed. A high school diploma is required, along with experience in healthcare operations. Candidates should be proficient in Microsoft Office and possess excellent communication and organizational skills. This position offers a salary range of €37,900 - €51,200, alongside a robust benefits package promoting work-life balance.

Leistungen

Generous vacation and sick time

Market-leading paid family leave

401(k) employer match

Qualifikationen

• 1+ years experience in healthcare operations or appeals.
• Ability to prioritize and organize multiple tasks with tight deadlines.
• Keyboarding skills.

Aufgaben

• Investigate and resolve member and provider appeals.
• Monitor shared mailboxes and ensure cases are entered correctly.
• Collaborate with internal departments to resolve issues.

Kenntnisse

Excellent verbal communication

Excellent organizational skills

Research skills

Proficient with Microsoft Excel

Ability to work in high-stress environment

Ausbildung

High School Diploma or GED

Bachelor's degree in business or healthcare

Tools

Microsoft Word

Microsoft Outlook

Jobbeschreibung

Job Description:

The Opportunity:

• Investigate, document and resolve member and provider appeals and inquiries related to appeals in accordance with State and/or Plan guidelines. Ensure all components of the appeal or request for information are researched and addressed.
• Assemble necessary information for the client so they may appropriately investigate an appeal when DentaQuest is secondary. If contracted to do so, also investigate the appeal and provide recommended outcome and appropriate correspondence.
• Monitor shared mailboxes and department e‑mails to ensure cases are properly entered into department tracking system, and that requests are acknowledged and resolved timely and accurately.
• Manage workflow to meet department, Plan, State, and company goals and deadlines.
• Comply with and complete any client directives or overturns.
• Collaborate and partner with Complaint & Grievance team to resolve common issues and trends.
• Take the lead in working with other internal departments/management team to ensure that any trends identified in appeals are communicated and rectified.
• Keep 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 standard workflows.
• Attend client or market meetings as assigned and share any new issues/changes that may be impactful.
• Establish and maintain professional 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 all letter templates in use are correct and most recent versions are used.
• Identify areas for improvement or processes that are unproductive, time‑consuming, and/or inefficient and communicate that information to management.
• Other duties as assigned.

Qualifications and Requirements:

• High School Diploma or GED required.
• 1+ years experience in healthcare operations or appeals; or related field.
• Proficient with general computer software including Microsoft Excel, Word and Outlook.
• Excellent verbal, written, interpersonal, organizational and communication skills.
• Excellent research skills with ability to identify underlying issue(s) even if not articulated.
• Ability to remain calm and focused 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 as they relate to complaints and grievances.
• Previous experience in claims billing or prior authorizations.
• Bachelor's degree in business, healthcare or equivalent.
• Keyboarding skills.

Salary Range:

Salary Range: $37,900 - $51,200

At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions.

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Benefits:

At Sun Life, we prioritize your well‑being with comprehensive benefits, including generous vacation and sick time, market‑leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programmes and a partially paid sabbatical programme. Plan for your future with our 401(k) employer match, stock purchase options and an employer‑funded retirement account. Enjoy a flexible, inclusive and collaborative work environment that supports career growth.

We will make reasonable accommodations to the known physical or mental limitations of otherwise‑qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email [e-mail] to request an accommodation.

For applicants residing in California, please read our employee California Privacy Policy and Notice.

We do not require or administer lie detector tests as a condition of employment or continued employment.

Sun Life will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including applicable fair chance ordinances.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.