Remote Appeals & Resolution Specialist

Devoted Health Services, Inc; Waltham (MA); On-site; USD 32,000 - 41,000; Full time

Benefits offered by this job

Health, dental and vision plan

Monthly mobile stipend $100

Stock options for all employees

Job summary

Devoted Health Services, Inc. is seeking an Appeals Specialist to join the Appeals Operations and Provider Escalations & Educations teams.

You will process appeals from plan Providers, Non-Contracted Providers, and Members, coordinating with clinical and claims teams to ensure timely, fair decisions. The role emphasizes timely, compliant reviews, data entry across CMS systems, and clear communication with members and providers.

Qualifications

• Bachelor's degree or equivalent experience in health care, conflict resolution, or related field.
• Detail oriented - data integrity is essential in this role.
• Strong computer, analytical, oral and written communication skills.

Responsibilities

• Correspond with members and providers by written communication and telephone contact.
• Coordinate with Managers, internal departments and external vendors to investigate, review, and resolve an appeal and the research needed to prepare the case for internal or external review.
• Manage the receipt, investigation, and resolution of appeals in a timely, compliant, and highly effective manner.
• Maintain a current knowledge of Devoted Health products, policies and procedures with the ability to relate this information clearly to members, providers, and others.
• Complete data entry and documentation requirements in multiple systems to ensure required CMS universe details are captured.

Skills

Analytical skills

Strong communication skills

Detail oriented

Education

Bachelor's degree or equivalent experience in health care, conflict resolution, or related field

Job description

Devoted Health Services, Inc. is seeking an Appeals Specialist to join the Appeals Operations and Provider Escalations & Educations teams.

You will process appeals from plan Providers, Non-Contracted Providers, and Members, coordinating with clinical and claims teams to ensure timely, fair decisions. The role emphasizes timely, compliant reviews, data entry across CMS systems, and clear communication with members and providers.