Appeals Analyst

MedPro Group•Springfield, MA

2d•Hybrid

About The Position

Wellfleet, a Berkshire Hathaway company, delivers customer-centric accident and health insurance, with quality service and uncompromising ethics. Wellfleet works to protect people against risk throughout every stage of life – from grade school to college to the workplace. Founded in 1993 as Consolidated Health Plans (CHP), Wellfleet, headquartered in Springfield, Mass., is one of the nation’s leading providers of health and accident insurance products to the higher education market. We are seeking an experienced Appeals Analyst to support the Wellfleet Legal team. If that's you, come join our growing team! The ideal candidate in this position will be responsible for the timely review of all Appeals and Complaints for all product lines administered by Wellfleet.

Requirements

Associate’s Degree and 3+ years relevant work experience or equivalent combination of education and experience.
Detail oriented with strong communication skills.
Strong organizational skills, including thorough and complete follow-up to all time-sensitive items.
Excellent written and verbal communication skills.
Excellent interpersonal skills.
Commitment to a team-oriented office environment.
Internet savvy and proficient with Microsoft Word, Outlook, and Excel.
Ability to interpret policy language.
Demonstrated business writing proficiency in accordance with regulatory requirements, internal policies, and claim events.
Strong aptitude and familiarity with medical coding and medical terminology.
Strong understanding and familiarity of the different state regulations.
Must demonstrate excellent written communication skills
Detail oriented problem solver with good time management skills.

Responsibilities

Analyze and respond to appeals and Department of Insurance complaints in accordance with policy language, applicable regulatory requirements, and required state and federal timeframes.
Prepare and send required acknowledgements and correspondence within applicable deadlines.
Gather, review, and maintain documentation needed to support appeal and complaint responses, including accurate appeal-system documentation.
Conduct research and analysis using approved guidelines and tools, with consideration of accreditation standards, state and federal regulatory requirements, legal requirements, benefits, COB, ACA, HIPAA Privacy, and claims payment rules.
Work with Compliance and other departments to monitor requirements, identify trends, and support process improvements.
Follow up on inquiries, requests, and task assignments through completion.
Maintain working knowledge of new and existing products, systems, and workflows, including LuminX, Spartacus, and Microsoft Office.
Communicate with carriers and internal departments as needed, including escalated appeal inquiries.
Follow management-approved workflows and make independent decisions based on available research and documentation.
Manage multiple priorities and meet required deadlines.
Provide back-up support to the Appeals Manager, including regulatory, carrier, and interdepartmental reporting requests; staff onboarding, training, and refresher training; and review of new appeals legislation to support updates to departmental processes and letters.
Perform other duties as assigned.