Nebraska Licensed Appeals Specialist

Job Summary

To support a mission-driven organization, the full-time Nebraska Licensed Appeals Specialist will perform appeals medical reviews remotely, ensuring compliance with regulations and accurate resolutions for claims, pre-certifications, and pre-authorizations.

Key responsibilities

• Adhere to State and Federal regulations and BCBSNE policies during the appeal resolution process
• Conduct accurate and timely medical reviews of appeal requests and related inquiries
• Collaborate with healthcare providers and internal teams to promote high-quality, cost-effective care

Required qualifications

• Bachelor's degree in Nursing or a health-related field
• Three years of clinical/medical-surgical experience in an acute care setting
• Active, current, and unrestricted Registered Nurse license from Nebraska or a participating consortium state
• Ability to work rotating weekend/holiday shifts as needed
• Demonstrated clinical skills and problem-solving abilities