Appeals Specialist

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Organize and finalize all claim appeals received within the Appeal Department.

• Evaluate appeals along with their supporting documentation.

• Analyze Summary Plan Documents to assess the validity of appeals.

• Draft response letters for appeals when required.

• Liaise with other departments and clients as necessary.

• Record the status and outcomes of appeals in the QicLink system and database.

• Communicate via email with claims examiners and other units when needed.

• Prioritize incoming referrals and ensure timely completion of tasks.

• Carry out additional related responsibilities as assigned.

⛳️ Requirements

• A High School diploma or equivalent is required.

• A minimum of 3 years of extensive experience in billing or managing medical, dental, and vision claims is required.

• Proficient in Excel and Word applications.

• Experience with or the ability to learn Microsoft Access.

• Effective oral and written communication skills.

• Capability to analyze claims situations and implement appropriate actions.

• Strong documentation and communication abilities.

• Proven track record of delivering excellent quality results.

• Access to cable broadband or fiber optic internet service with a minimum of 100Mbps download and 25Mbps upload speeds.

🏝️ Benefits

• Medical insurance.

• Dental insurance.

• Vision insurance.

• Life insurance.

• Disability insurance.

• Generous paid time off.

• Tuition reimbursement.

• Employee assistance program (EAP).

• Technology stipend.

• Flexible remote work arrangements, allowing for comfort while working from home.