Clinical Claims Appeals Specialist - WV

Location: Remote
Compensation: To Be Discussed
Staff Reviewed: Sun, May 12, 2024
This job expires in: 23 days

Job Summary

A company is looking for a Clinical Claims Appeals Specialist.

Key Responsibilities:
  • Evaluate and analyze claim appeals to determine validity and appropriateness
  • Communicate with policyholders and healthcare providers to gather information and clarify claim details
  • Maintain accurate records of appeal cases, prepare reports, and identify process improvement opportunities

Required Qualifications:
  • Current unencumbered licensure as a registered professional nurse or practical nurse with relevant clinical experience
  • Three years of experience in clinical claims processing and review, including appeals and grievances
  • Bachelor's degree in healthcare, coding, or nursing discipline OR eight years of relevant claims experience in a clinical or insurance setting
  • Minimum five years of operational managed care experience
  • Proficiency in Medicare/Medicaid guidelines and regulatory requirements

COMPLETE JOB DESCRIPTION

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