Appeals Specialist I

📋 Description

• Research and resolve member and provider appeals, disputes, grievances, complaints, and
• Investigate claims appeals and grievances using relevant support systems to determine appropriate
• Request and review medical records, clinical notes, detailed bills, and other supporting
• Apply established protocols, benefit provisions, contract language, and covered-service guidelines
• Research claims processing guidelines, provider contracts, fee schedules, and system configurations
• Prepare concise, accurate appeal summaries, findings, correspondence, and written determinations in

🎯 Requirements

• High school diploma or equivalent.
• At least 2 years of operational managed care experience, ideally within a call center, appeals
• Experience with health claims processing, including coordination of benefits, subrogation, and
• Familiarity with Medicare and Medicaid claims denials, appeals processing, and applicable
• Strong understanding of healthcare claims workflows, benefits, provider contracts, and payment
• Excellent written and verbal communication skills, with the ability to explain complex information

🎁 Benefits

• $21.92/hour on W-2, all-inclusive.
• Fully remote work arrangement.
• Full-time contract position initially scheduled for 14 weeks, with potential for extension or
• Monday–Friday schedule, 8:00 AM–4:30 PM.
• Four medical insurance options for eligible full-time employees working at least 30 hours per week.
• Dental and vision insurance.