Appeals Review Specialist

Job Summary

To ensure plan assets are protected, the full-time hourly Appeals Review Specialist will review claims for errors, respond to inquiries from members and providers, and maintain regulatory compliance while working remotely.

Key responsibilities

• Verify claim accuracy against medical records and review for potential fraud and abuse
• Research and respond to inquiries from members and providers regarding denied coverage and provide denial explanations
• Participate in quality assurance initiatives and collaborate with teams to improve internal processes and customer satisfaction

Required qualifications

• High School Diploma or equivalent
• Minimum of two years of experience in claims examining or related work
• Working knowledge of Microsoft Office products
• Proficient typing and 10-key skills
• Ability to maintain confidentiality and demonstrate neutrality in communications