Appeals Specialist

Allied Benefit Systems • Chicago, IL

5d • $20 - $21 • Remote

About The Position

The Appeals Specialist is responsible for monitoring and tracking the status of appeals as they relate to the Allied Advocate program. The position involves but is not limited to reviewing appeals for appropriateness, documenting the claim specifics into the current software and routing documentation to business partners for review/resolution. The Appeals Specialist also provides follow up with business partners on aging appeals. The Appeals Specialist requires a strong knowledge of medical claims processing. This position also coordinates with Allied business partners for documenting and tracking appeals.

Requirements

• 2 years of comprehensive experience with the handling of medical claims appeals experience required.
• Proficient with Microsoft Office Suite or related software required.
• Ability to analyze claim situations and take appropriate actions.
• Excellent verbal and written communication skills.
• Strong analytical and problem-solving skills.
• Excellent organizational skills and attention to detail.
• Excellent time management skills with a proven ability to meet deadlines.
• Ability to learn new systems.

Responsibilities

• Logging/tracking all appeals received
• Reviewing appeal and supporting documentation
• Reviewing Summary Plan Documents to determine validity of appeal
• Composing appeal response when necessary
• Communicating with other departments and the clients when necessary
• Documenting the Qiclink system and database with appeal status and outcome
• Coordinating appeal response with business partners
• Prioritize incoming referrals to complete all tasks timely
• Other duties as assigned

Benefits

• Medical, Dental, Vision, Life & Disability Insurance
• Generous Paid Time Off
• Tuition Reimbursement
• EAP
• Technology Stipend

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 501-1,000 employees