Appeal Examiner- Meritain Health
About The Position
The Appeal Examiner is responsible for managing, to resolution, appeal scenarios. These may contain responses from multiple business units. This person is responsible for ensuring timely, customer focused responses. In this role, you will: Review and analyze any relevant appeals as assigned. Interpret any policy and coverage guidelines as dictated by organizational policy and supervisory discretion. Coordinate reviews as needed. Draft resolution letters in order to ensure a timely and accurate response. Ensure timely handling of assigned cases, contingent on departmental workload and assignments.
Requirements
- 1+ years customer service experience in a metrics driven environment.
- 1+ years administrative experience.
- Working knowledge of Microsoft Office products (Word, Excel, PowerPoint, Outlook).
- High school diploma or GED.
Nice To Haves
- 1+ years of experience with plan documents, appeals, compliance and/or claim research.
- 1+ year of experience with interpreting health plans and benefits.
- Strong familiarity with medical terminology, self-funding, and/or ERISA (Employee Retirement Income Security Act) requirements.
Responsibilities
- Review and analyze any relevant appeals as assigned.
- Interpret any policy and coverage guidelines as dictated by organizational policy and supervisory discretion.
- Coordinate reviews as needed.
- Draft resolution letters in order to ensure a timely and accurate response.
- Ensure timely handling of assigned cases, contingent on departmental workload and assignments.
Benefits
- medical
- dental
- vision coverage
- paid time off
- retirement savings options
- wellness programs
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
