Appeals Specialist II

Job Summary

Supporting the documentation and processing of appeals, the full-time Appeals Specialist II will review and investigate requests, ensuring compliance with regulatory guidelines while working remotely.

Key responsibilities

• Perform data entry to track, log, and process appeals, disputes, and reconsiderations in line with established guidelines
• Prepare correspondence and maintain documentation files for appeals, disputes, and reconsiderations
• Conduct research to evaluate and respond to appeals, ensuring timely decision-making and reporting on trends and outcomes

Required qualifications

• High School diploma or GED
• 1 - 2 years of related experience in claims, appeals, or authorizations
• Familiarity with TruCare Classic/Cloud, CenPas, Amisys, or Prime preferred
• Knowledge of the appeals, disputes, and reconsiderations process preferred
• Authorization to work in the U.S. without the need for employment-based visa sponsorship