Claims Appeals Specialist

Job Summary

A company is looking for an Appeals Specialist to manage claim appeals within the Appeal Department.

Key Responsibilities

• Reviewing appeal and supporting documentation to determine validity
• Composing appeal response letters and documenting outcomes in the QicLink system
• Prioritizing incoming referrals and communicating with other departments as needed

Required Qualifications, Training, and Education

• High School diploma or equivalent required
• 3 years or more of experience handling medical, dental, and vision claims
• Proficiency in Excel and Word; experience with Microsoft Access is a plus
• Ability to analyze claim situations and document outcomes effectively
• History of excellent quality results and a willingness to take on new challenges