Medical Claims Appeals Specialist

Allied Benefit Systems; United States; Remote; USD 80,000 - 100,000; Full time

Job summary

An established industry player is seeking an Appeals Specialist to manage claim appeals within a dynamic and supportive environment. This role involves logging and tracking appeals, reviewing documentation, and composing response letters, all while ensuring effective communication with various departments and clients. The ideal candidate will have a strong background in handling medical claims, proficient skills in Excel and Word, and a commitment to delivering excellent results. If you're ready to take on new challenges and contribute to a vital function in the healthcare system, this opportunity is perfect for you.

Qualifications

• 3+ years of experience handling medical, dental, and vision claims.
• Proficient in Excel and Word, with a willingness to learn Access.

Responsibilities

• Log and track all appeals received and review supporting documentation.
• Compose appeal response letters and communicate with departments.

Skills

Communication

Customer Focus

Accountability

Analytical Skills

Email Communication

Education

High School diploma or equivalent

Tools

Excel

Word

Microsoft Access

Job description

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

ESSENTIAL FUNCTIONS

1. Logging/tracking all appeals received
2. Reviewing appeal and supporting documentation
3. Reviewing Summary Plan Documents to determine validity of appeal
4. Composing appeal response letters when necessary
5. Communicating with other departments and clients when necessary
6. Documenting the QicLink system and database with appeal status and outcome
7. Emailing claims examiners and other units when necessary
8. Prioritizing incoming referrals to complete all tasks timely
9. Performing 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 medical, dental, and vision claims required.
• Proficient in the use of Excel and Word programs
• Experience with or ability to learn Microsoft Access
• Ability to communicate effectively both orally and by email
• Ability to analyze claim situations, take appropriate actions, and maintain excellent communication and documentation.
• A history of excellent quality results and the desire to take on new challenges 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.