Appeals Specialist II
Remote · from United States
Core
Process and adjudicate complex non-utilization management appeals and respond to member inquiries regarding appeals.
Role type
Appeals Specialist
Builds
Adjudicated appeal decisions and member responses
Domain
Health Insurance / Medical Claims
Required skills
Medical terminology, coding knowledge, federal/state/NCQA guidelines analysis, customer complaint resolution, task organization
Preferred skills
Claims processing experience, claims payment system utilization, bilingual English/Spanish
Responsibilities
Process and adjudicate complex non-utilization management appeals; Respond to member inquiries via phone, in person, or writing; Train and mentor less experienced appeals specialists
Seniority
Mid-level IC