Strategic Appeals Specialist

Independence Blue Cross; Philadelphia (Philadelphia County); On-site; USD 55,000 - 75,000; Full time

Job summary

Talentify is seeking an Appeals Specialist to investigate and resolve member and provider appeals with precision. You will research benefits, claims history, and eligibility, preparing thorough case files for clinical or administrative review.

Clear communication with stakeholders and meticulous documentation are essential to ensure timely, compliant resolutions. Ideal candidates possess strong research and analytical skills, excellent written and verbal communication, and the ability to manage

Qualifications

• Associate degree or equivalent education and relevant experience in health insurance operations.
• Experience in appeals, grievances, claims, or health insurance operations preferred.
• Strong research, analytical, and problem-solving abilities.
• Detail-oriented with accurate, compliant case documentation.

Responsibilities

• Investigate and resolve member and provider appeals and grievances timely and accurately.
• Research benefits, claims history, eligibility, and provider records for each case.
• Prepare complete case files and communicate outcomes with stakeholders.
• Document case activity and rationale in designated systems.
• Coordinate with internal and external resources to support case resolution.

Skills

Attention to detail

Written communication

Verbal communication

Time management

Multitasking

Research skills

Analytical skills

Problem solving

Documentation

Collaboration

Privacy & information security

Education

Associate degree

Tools

Microsoft Word

Excel

Outlook

Case management systems

Job description

Talentify is seeking an Appeals Specialist to investigate and resolve member and provider appeals with precision. You will research benefits, claims history, and eligibility, preparing thorough case files for clinical or administrative review.

Clear communication with stakeholders and meticulous documentation are essential to ensure timely, compliant resolutions. Ideal candidates possess strong research and analytical skills, excellent written and verbal communication, and the ability to manage