State Licensed Appeals Specialist

Job Summary

A company is looking for an Appeals Specialist.

Key Responsibilities

• Review and develop action plans for appealed claims according to policy provisions
• Conduct timely appeals reviews and communicate outcomes to relevant parties
• Perform claim audits and analyze data to identify trends and compliance issues

Required Qualifications

• A minimum of 5 years of experience in managing claim appeals and audits
• Knowledge of ERISA, HIPAA, and insurance laws in the United States
• Strong understanding of Short Term Disability, Long Term Disability, and Life claims processing
• Bachelor's degree preferred; high school diploma required
• State licensing as required by the company