Entry Level Appeals Specialist

Job Summary

Providing entry-level support for claims activities, the full-time Entry Level Appeals Specialist will review and resolve member and provider complaints while ensuring compliance with CMS standards, working in a healthcare environment.

Key responsibilities

• Enter denials and requests for appeals into the information system and prepare documentation for further review
• Research claims issues and assure the timeliness and appropriateness of appeals according to guidelines
• Generate and mail denial letters, and collaborate with provider and member services to resolve complaints

Required qualifications

• At least 1 year of experience in claims or customer/provider service in a healthcare setting, or equivalent education and experience
• Proficiency in Microsoft Office suite or applicable software programs
• Strong organizational and time management skills to manage multiple projects
• Effective verbal and written communication skills