Expedited Appeals Specialist

Job Summary

Working remotely, the full-time Expedited Appeals Specialist will process complex expedited appeals, ensuring compliance and accuracy under tight deadlines while managing member and provider correspondence and conducting thorough investigations.

Key responsibilities

• Independently perform triage functions to review and evaluate appeal requests, determining eligibility and benefits
• Conduct thorough investigations of correspondence, preparing detailed case summaries for administrative review
• Monitor compliance with regulatory requirements and operational standards, ensuring timely resolution of cases

Required qualifications

• Bachelor's degree
• 3 - 5+ years of related experience, preferably in the health industry and/or compliance
• Extensive knowledge of claims, enrollment, benefits, and member contracts
• Proficiency in MS Office applications
• Ability to mentor specialists and manage complex cases