Appeals Specialist II

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

📋 Description

• Evaluate and resolve intricate non-utilization management appeals in compliance with relevant federal, state, and NCQA standards and regulations.

• Address inquiries related to members’ appeal requests through phone, in-person meetings, or written communication.

• May provide training and guidance to less experienced Appeals Specialists.

⛳️ Requirements

• High School Diploma or GED.

• A minimum of 3 years’ experience in a customer service position or within a health insurance or medical setting.

• Familiarity with medical terminology, including coding.

• Skills and experience to analyze and assist customers based on knowledge of federal, state, and NCQA guidelines.

• Ability to organize tasks and manage a substantial volume of reference materials.

• Proficiency in understanding the intricate details of customer complaint issues.

• Strong verbal and written communication skills.

• This position can be executed remotely from anywhere in the continental United States, excluding California, New York, Alaska, and Hawaii.

🏝️ Benefits

• Curated development plans and opportunities for professional growth.

• Health and wellness benefits.

• 401(k) savings plan.

• Pension plan.

• Paid time off.

• Paid parental leave.

• Disability insurance.

• Supplemental life insurance.

• Employee assistance program.

• Paid holidays.

• Tuition reimbursement.

• Additional incentives.

• Annual incentive bonus plan, subject to plan terms and conditions.