[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.

Essential Functions

• 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
• Performs 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
• Applicant should be proficient in the use of the Excel and Word programs
• Experience with or ability to learn Microsoft Access
• Be able to communicate effectively both orally and by email
• Applicant must have the ability to analyze claim situations, take appropriate actions and be great with communication and documentation
• Applicant must have a history of excellent quality results and the desire to take on a new challenge if currently employed at Allied

Requirements

• Communication
• Customer Focus
• Accountability
• Functional/Technical Job Skills

Physical Demands

• This is a standard desk role – long periods of sitting and working on a computer are required

Work Environment

• Remote

Benefits

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