[Hiring] Appeals Specialist @Allied Benefit Systems

Role Description

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

• Reviewing appeal and supporting documentation
• Reviewing Summary Plan Documents to determine validity of appeal
• Composing appeal response letters when necessary
• Communicating with other departments and clients when necessary
• Documenting the QicLink system and database with appeal status and outcome
• Emailing claims examiners and other units when necessary
• Prioritize incoming referrals to complete all tasks timely
• Other related duties as assigned

Qualifications

• High School diploma or equivalent required
• 3 years or more of comprehensive experience with the billing of or otherwise handling of 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 be great with communication and documentation
• History of excellent quality results

Requirements

• Accountability
• Communication
• Customer Service Orientation
• Functional/Technical Skills
• Quality Focus
• Time and Task Management

Physical Demands

This is a standard desk job requiring extended sitting and computer work.

Work Environment

Remote

Benefits

• Medical, Dental, Vision, Life and Disability Insurance
• Generous Paid Time Off
• Tuition Reimbursement
• EAP
• Technology Stipend