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
COMPLETE JOB DESCRIPTION
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