Healthcare Appeals Examiner: Precise, Compliant Case Reviews

Wipro; Tampa (FL); On-site; USD 40,000 - 44,000; Full time

Benefits offered by this job

Full range of medical and dental benefits

Disability insurance

Paid time off, including sick leave

Job summary

A healthcare service provider is looking for an Appeals Examiner to manage provider reconsiderations and appeals. This role requires strong problem-solving skills and a commitment to compliance. The ideal candidate will coordinate appeals processes, document outcomes meticulously, and collaborate with internal teams for resolution. Applicants should have a high school diploma, with further education preferred, and familiarity with healthcare coding systems is beneficial. The expected salary ranges from $40,000 to $44,000 annually, with a full benefits package provided.

Qualifications

• High school diploma or GED equivalent is required.
• Proven problem-solving abilities required.
• Working knowledge of healthcare coding systems preferred.

Responsibilities

• Coordinate review and resolution of member appeals.
• Document all case actions for auditing.
• Collaborate with internal teams for case resolution.
• Interpret Summary Plan Documents for appeal validity.
• Ensure compliance with HIPAA regulations.

Skills

Problem-solving abilities

Interpersonal communication

Time management

Education

High School diploma or GED

Certifications in healthcare administration

Tools

Microsoft Office Suite

Claims management software

Job description

A healthcare service provider is looking for an Appeals Examiner to manage provider reconsiderations and appeals. This role requires strong problem-solving skills and a commitment to compliance. The ideal candidate will coordinate appeals processes, document outcomes meticulously, and collaborate with internal teams for resolution. Applicants should have a high school diploma, with further education preferred, and familiarity with healthcare coding systems is beneficial. The expected salary ranges from $40,000 to $44,000 annually, with a full benefits package provided.