Medical Claims Appeals Specialist

Position Summary

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.

Essential Functions

• 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
  
  

Education

• Bachelor’s degree or equivalent work experience required.
  
  

Experience & Skills

• 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.
  
  

Competencies

• Communication
• Customer Focus
• Accountability
• Functional/Technical Job Skills
  
  

Physical Demands

• Ability to sit for long periods of time. Ability to communicate via telephone.
  
  

Work Environment

• Remote
  
  

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 & 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.