Appeals Specialist
Unified Group Services
Date: 2 weeks ago
City: Anderson, IN
Contract type: Full time
Appeals may be submitted by providers and/or their representatives, members, attorneys, and sometimes a PPO (Preferred Provider Organization) may request a review. JOB DESCRIPTION:
- Research internal/external appeal (benefit determination, Usual and customary reduction, discount dispute, eligibility).
- Work with internal review vendors on internal appeals and independent review organizations (IRO) on external reviews. This essential team review requires the employee to work inside the office.
- Work with our clients, reinsurance department, subrogation department, case management/pre-cert vendors, PPOs on occasion
- Draft letters in response to appeal (providers, provider representatives, members, occasionally an attorney)
- Adhere to plan timeframes regarding all aspects of appeals
- As with any job, there may be other tasks assigned as necessary.
- High School Diploma or GED. Some college is helpful but not required
- Working knowledge of Microsoft Word, Excel, and Outlook is required
- Strong math skills.
- Attention to detail and the ability to meet deadlines are critical to success.
- Professional phone communication skills.
- Good organizational skills and excellent customer service.
- Good writing skills, using proper grammar, punctuation, and sentence structure.
- Problem-solving and decision-making skills are vital
- Self-motivated & self-starter with a willingness to learn.
- Excellent attendance.
- Medical, dental, and vision insurance
- Matching 401K plan
- Life insurance
- Short and Long-term disability
- Student loan debt payments
- Vacation and PTO time
- Health Clinic
- Sponsored wellness plans.
- Family-oriented, positive work environment
- Weekends off
- Voluntary overtime during peak season
- Recently voted one of the Best Places to Work in Indiana!
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