Health Admin Services New Associate-Voice
Core
Reviewing and processing appeals for denied insurance claims, evaluating reasons for denial, gathering information, and making decisions on appeal resolution.
Role type
Associate Claims Appeals Specialist
Builds
Fair and accurate resolution of health, life, and property & causality claims
Domain
Healthcare insurance claims administration
Deliverable
client delivery
Required skills
Claims appeals processing, regulatory guidelines adherence, documentation analysis, clinical criteria evaluation, medical policy interpretation, communication with claimants
Preferred skills
English fluency (US Berlitz B2 or Versant 58+), basic computer proficiency
Technologies
Client-specific criteria sets (e.g., Milliman, InterQual)
Responsibilities
Conduct pre-service and retrospective Provider and Member Appeals for outpatient and inpatient requests; Utilize client specific criteria sets and medical policies for decision making; Accurately route cases to client medical staff for further review; Ensure member access to medically necessary, quality healthcare in a cost-effective setting
Seniority
Entry-level, supervised individual contributor