Employer Industry: Healthcare Insurance

Why consider this job opportunity:
- Salary up to $83,028
- Comprehensive benefits package including various incentive programs and 401k contribution plans
- Opportunity for career advancement and growth within the organization
- Work remotely from within the greater Baltimore metropolitan area with occasional in-office meetings
- Supportive and collaborative work environment with a focus on training and mentoring

What to Expect (Job Responsibilities):
- Conduct independent research on contractual benefits, limitations, exclusions, and claims to assist in the review of appeals
- Prioritize, analyze, and perform accurate data entry for complex appeals, including high-profile cases
- Utilize professional communication skills to respond to appeals and reconsiderations based on State and Federal requirements
- Train and mentor entry-level associates while participating in discussions about appeal processes
- Collaborate with internal and external stakeholders while maintaining confidentiality of medical information

What is Required (Qualifications):
- High School Diploma or GED
- Minimum of 5 years of experience in managed care, healthcare, or insurance payor environments
- At least 2 years of experience in Appeals Management
- Strong research and problem-solving skills
- Excellent organizational and analytical skills

How to Stand Out (Preferred Qualifications):
- College degree
- Knowledge of the employer's system, Member/Provider Service, Claims, or Care Management experience

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