APPEALS SPECIALIST POSITION SUMMARY The Appeals Specialist will be responsible for the organization and completion of all claim appeals received in the Appeal Department.
ESSENTIAL FUNCTIONS - Logging/tracking all appeals received
- 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
- Performs other related duties as assigned
EDUCATION - 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 and the desire to take on a new challenge if currently employed at Allied.
POSITION COMPETENCIES - Communication
- Customer Focus
- Accountability
- Functional/Technical Job Skills
PHYSICAL DEMANDS This is a standard desk role - long periods of sitting and working on a computer are required.
WORK ENVIRONMENT 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.