Claims Appeals Specialist: Solve Complex Benefit Challenges

Unified Group Services; Anderson (IN); On-site; USD 40,000 - 60,000; Full time

Benefits offered by this job

Health, dental, and vision insurance

401(k) with company match

Education assistance

Employee assistance program

PTO

Growth opportunities

HSA/FSA

Life insurance

Short- and long-term disability

Wellness programs

Sponsored health clinic

Company parties

Job summary

Unified Group Services in Anderson, IN is seeking a full-time Claims Appeals Specialist to join our team. This role focuses on researching and resolving complex appeals, ensuring accurate determinations for members and clients.

You will collaborate with internal reviewers and IROs, draft clear response letters, and maintain timely communication with providers, members, and vendors. The ideal candidate has strong analytical skills, attention to detail, and the ability to meet deadlines.

Qualifications

• High school diploma or equivalent.
• Proficiency in MS Word, Excel and Outlook.
• Strong mathematical and analytical skills.
• Exceptional attention to detail.
• Ability to meet critical deadlines.
• Excellent writing skills preferred.

Responsibilities

• Investigate and review internal and external appeals related to benefit determinations, Usual & Customary reductions, discount disputes and eligibility concerns.
• Collaborate with internal review vendors and IROs to ensure accurate and efficient handling of appeals.
• Draft professional letters to providers, members, representatives, and attorneys; maintain clear communication with claims processors and clients.

Skills

Analytical skills

Attention to detail

Deadline-oriented

MS Word

Excel

Outlook

Strong writing skills

Education

High school diploma or equivalent

Tools

MS Word

Excel

Outlook

Job description

Unified Group Services in Anderson, IN is seeking a full-time Claims Appeals Specialist to join our team. This role focuses on researching and resolving complex appeals, ensuring accurate determinations for members and clients.

You will collaborate with internal reviewers and IROs, draft clear response letters, and maintain timely communication with providers, members, and vendors. The ideal candidate has strong analytical skills, attention to detail, and the ability to meet deadlines.