Appeals Specialist

📋 Description

• Manage the receipt, investigation, review, and resolution of appeals submitted by health plan
• Ensure all appeals are processed accurately, efficiently, and within established timelines and
• Conduct detailed case investigations, gathering relevant information and documentation to support
• Coordinate with internal departments, including Clinical, Medical Directors, Utilization Management
• Collaborate with managers, external vendors, and other stakeholders throughout the investigation
• Communicate with members, healthcare providers, and their representatives through written

🎯 Requirements

• Bachelor's degree in Healthcare, Conflict Resolution, or a related field, or equivalent relevant
• Strong computer skills, with the ability to navigate multiple systems, manage electronic records
• Excellent analytical and investigative abilities, with the capacity to evaluate complex
• Exceptional attention to detail, particularly when handling sensitive information, maintaining case
• Excellent written and verbal communication skills, with the ability to explain policies
• Strong interpersonal and customer service skills, with the ability to communicate effectively and

🎁 Benefits

• Competitive hourly compensation: $23–$30 per hour, depending on qualifications, relevant
• Employer-sponsored healthcare coverage, including medical, dental, and vision insurance, with low
• Generous paid time off.
• Monthly mobile phone or internet stipend of $100.
• Stock options available to employees.
• Bonus eligibility for applicable positions.