Appeals Specialist II
Job Summary
Supporting the documentation and processing of appeals, the full-time Appeals Specialist II will manage appeals, disputes, and reconsiderations to ensure compliance with state and NCQA requirements while working remotely.
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 actions and ensure timely decisions
Required qualifications
- High School diploma or GED
- 1 - 2 years of related experience
- Knowledge of appeals, disputes, and reconsiderations processes preferred
- Experience with No Surprises Act (NSA) Open Negotiation Requests (ONRs) and Independent Dispute Resolution (IDR) preferred
- Authorization to work in the U.S. without the need for employment-based visa sponsorship
Complete Job Description
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