Appeals Specialist

Job Summary

A company is looking for an Appeals Specialist II to support the documentation and processing of appeals, disputes, and reconsiderations.

Key Responsibilities

• Perform data entry to track, log, and process appeals, disputes, and reconsiderations according to regulatory guidelines
• Prepare correspondence and maintain documentation files for appeals, disputes, and reconsiderations
• Review and investigate requests to determine necessary follow-up and conduct research for timely decisions

Required Qualifications

• High School diploma or GED required
• 1 - 2 years of related experience preferred
• Knowledge of the appeals, disputes, and reconsiderations process preferred
• Experience reviewing medical/clinical documents preferred
• Claims processing experience highly preferred