[Hiring] Appeals Specialist @Devoted Health

Role Description

The Appeals Specialist is an integral part of our Appeals Operations team & our overarching Provider Escalations & Educations team. The Appeals Specialist is responsible for the timely processing & effective decision making on Appeals received from plan Providers, Non-Contracted Providers, & our Members or their appointed representatives. This individual will work cross functionally with areas such as Clinical, Medical Directors, UM, & claims to ensure we’re making appropriate decisions on our appeal reviews.

Your Responsibilities and Impact will include:

• Correspond with members and/or providers as required (i.e., written communication and telephone contact along with documentation as appropriate)
• Coordinate with Managers, internal departments and external vendors relative to the investigation, review, and resolution of 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 in a clear, concise and understandable manner to members, providers, and other individuals, both internal and external
• Complete data entry and documentation requirements in multiple systems to ensure required CMS universe details are captured appropriately

Qualifications

• Strong computer, analytical, oral and written communication skills
• Bachelor’s degree or equivalent experience in health care, conflict resolution, or related field
• Detail oriented - the data integrity is very important in this role and all of the documentation that goes with it

Requirements

• Superior investigation, customer service, interpersonal, and problem-solving skills
• Working knowledge of insurance products, policies, procedures, claims process

Benefits

• Employer sponsored health, dental and vision plan with low or no premium
• Generous paid time off
• $100 monthly mobile or internet stipend
• Stock options for all employees
• Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
• Parental leave program
• 401K program
• And more...

Company Description

Founded in 2017, Devoted Health is on a mission to dramatically improve the health and well-being of older Americans by caring for everyone like they are family, and that includes our employees. Our robust and seamlessly integrated care platform merges advanced data and AI access with world-class clinical and service experiences to create a member experience that is unlike the industry norm.

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law.