POSITION SUMMARY
The Appeals Specialist will be responsible for the organization and completion of all claim appeals received in the Appeal Department.
ESSENTIAL FUNCTIONS
- Reviewing appeal and supporting documentation
- Reviewing Summary Plan Documents to determine validity of appeal
- Composing appeal response letters when necessary
- Communicating with other departments and clients when necessary
- Documenting the QicLink system and database with appeal status and outcome
- Emailing claims examiners and other units when necessary
- Prioritize incoming referrals to complete all tasks timely
- Other related duties as assigned
- High School diploma or equivalent required
EXPERIENCE AND SKILLS
- 3 years or more of comprehensive experience with the billing of or otherwise handling of medical, dental and vision claims required.
- Applicant should be proficient in the use of the Excel and Word programs
- Experience with or ability to learn Microsoft Access
- Be able to communicate effectively both orally and by email
- Applicant must have the ability to analyze claim situations, take appropriate actions and be great with communication and documentation
- Applicant must have a history of excellent quality results
- Accountability
- Communication
- Customer Service Orientation
- Functional/Technical Skills
- Quality Focus
- Time and Task Management
PHYSICAL DEMANDS
- This is a standard desk job requiring extended sitting and computer work.
WORK ENVIRONMENT
- Remote
Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive.
The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
Compensation is not limited to base salary. Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life and Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.
Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process. It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role.
Skills Required
- High school diploma or equivalent
- Three or more years of comprehensive experience billing or handling medical, dental, and vision claims
- Proficiency with Microsoft Excel and Microsoft Word
- Experience with or ability to learn Microsoft Access
- Effective oral and email communication skills
- Ability to analyze claim situations and take appropriate action
- Strong documentation skills
- History of excellent quality results
- Reliable cable broadband or fiber internet with minimum speeds of 100 Mbps download and 25 Mbps upload
What We Do
Allied is a national healthcare solutions company that works with organizations who choose to take control of their healthcare. We customize employer self-insurance benefits to align with individual choice and organizational need while integrating medical management innovations and cost-control strategies. With healthcare designed for people, employers never have to choose between price and the best-fit insurance products to protect employees and their families. Allied’s philosophy is to create a culture of health for our member organizations and their employees beyond simple, medical health. We integrate administrative services, care solutions and analytics to achieve better clinical, behavioral and social patient outcomes. Allied’s programs and benefit services are designed and structured to infuse value on every front – for employers and HR departments, for plan members and their families, for healthcare providers, and for us. We’re in this together, committed to your future.
