Appeals Specialist

Job Summary

A company is looking for an Appeals Specialist responsible for managing and resolving non-clinical cases related to member and provider appeals.

Key Responsibilities

• Develop and resolve non-clinical cases including claim denials and member complaints
• Prepare and submit documented appeals in compliance with payer guidelines
• Identify trends in denials and provide feedback for process improvement

Required Qualifications

• HS Diploma or GED from an accredited institution
• Minimum of two (2) years of experience in Managed Care Health Insurance
• Experience with appeals for Medicare, Medicaid, and commercial plans
• Claims processing experience with coding criteria is preferred
• Bachelor's degree or relevant work experience is preferred