Senior Appeals Specialist

Job Summary

A company is looking for a Senior Policy and Appeals Specialist.

Key Responsibilities

• Review, investigate, and adjudicate complex member appeals and provider disputes
• Interpret plan documents and apply policy accurately to benefit determinations
• Collaborate with various departments to resolve escalations and complex cases

Required Qualifications

• High School Diploma
• 6+ years of experience in processing and analyzing medical claims
• 3+ years of experience with medical appeals and provider disputes
• Basic proficiency in Windows-based applications and virtual meeting tools
• General knowledge of CMS claims submission regulations