Appeals Coordinator (Fully Remote)

Arkansas Blue Cross and Blue Shield; United States; Remote; USD 85,000 - 105,000; Full time

Benefits offered by this job

tuition reimbursement

onsite gym

onsite dining

wellness incentives

Job summary

Arkansas Blue Cross and Blue Shield is seeking an experienced RN to review appeals of adverse benefit determinations. You will research medical necessity and coverage policy, and exercise independent judgment to ensure fair, compliant decisions.

The role requires an active RN license with 5 years of clinical nursing and at least 2 years in utilization review. You will collaborate with medical divisions and respond to state insurance department complaints.

Qualifications

• Active RN license required.
• 5 years of clinical nursing experience.
• 2 years of utilization review experience.

Responsibilities

• Reviews appeals of adverse benefit determinations under federal and state law.
• Exercises independent judgment to ensure decisions are fair and compliant.
• Researches appeal cases for medical necessity and coverage policy.
• Responds to state insurance department complaints and collaborates with medical divisions.

Skills

RN license

Clinical nursing experience

Utilization review experience

Job description

• Reviews appeals of adverse benefit determinations under federal and state law.
• Exercises independent judgment to ensure decisions are fair and compliant.

Responsibilities:

• Researches appeal cases for medical necessity and coverage policy.
• Responds to state insurance department complaints and collaborates with medical divisions.

Qualifications & Culture:

• Requires active RN license, 5 years clinical nursing, and 2 years utilization review experience.
• Benefits include tuition reimbursement, onsite gym, onsite dining, and wellness incentives.

Arkansas Blue Cross and Blue Shield

Arkansas Blue Cross and Blue Shield is a health insurance provider serving Arkansas. It is consistently ranked as one of the best places to work in Central Arkansas, with an inclusive culture and an average employee tenure of 10 years.