Claim Appeals Specialist – PACE

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

📋 Description

• Oversee and manage an inventory of essential and received client documentation.

• Coordinate and evaluate employer benefit plan documents along with stop loss policies.

• Engage in communication with clients concerning the receipt and progress of appeals.

• Receive, audit, and assess both final internal medical claims appeals and external medical claims appeals.

• Prepare and provide a summary of appeal content.

• Delegate appeals for review and formulate responses.

• Generate and coordinate timely updates and responses for clients.

• Conduct extensive computer work and effectively operate office equipment such as computers, copiers, and fax machines.

⛳️ Requirements

• A minimum of 2 years of experience with employer benefit plan documentation and the review of medical appeals.

• Proficiency in utilizing various case management software for tracking appeals.

• Outstanding organizational skills paired with keen attention to detail.

• Strong verbal and written communication abilities.

• Advanced proficiency in Microsoft Excel.

• Capability to multitask while maintaining a high level of attention to detail.

• Ability to manage stressful situations and meet deadline pressures effectively.

• Competence in planning and executing responsibilities with minimal guidance.

• Capability to perform essential job functions independently or with reasonable accommodations.

• Adherence to relevant citizenship and immigration-status employment practices.

🏝️ Benefits

• Comprehensive benefits package for employees.

• Commitment to equal opportunity employment.

• Provision of reasonable accommodations for qualified individuals with disabilities.