Claims Admin Appeals Coordinator

Job Description

SBMA, a third-party administrator, is an affordable ACA-compliant benefits provider to thousands of employers. Their goal is to simplify the complexity of providing employee benefits. SBMA is different because of its personal service, speed of implementation, and innovative approach to benefits coverage.

The Claims Admin/Appeals Coordinator provides essential clerical and administrative support to the Claims Department of an insurance Third-Party Administrator (TPA). This role ensures accurate processing, organization, and maintenance of claims while supporting the claims team. The ideal candidate is detail-oriented, highly organized, and comfortable working in a fast-paced, regulated environment.

To perform this job successfully, an individual must be able to satisfactorily perform each essential duty. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

RESPONSIBILITIES AND DUTIES (Included but not limited to):

• Provide administrative support to claims team
• Processing and tracking member/provider appeals
• Researching claims, plan provisions, and supporting documents
• Coordinating information needed for appeal determinations
• Monitoring appeal deadlines and turnaround times
• Identifying trends and recurring issues (to improve the BENEX tool)
• Supporting claims staff with administrative follow-up
• Perform other administrative and clerical duties as assigned

REQUIRED EDUCATION AND EXPERIENCE:

• High school diploma or equivalent; associate degree or coursework in business or insurance preferred
• 1–3 years of administrative or clerical experience, preferably in insurance, claims, healthcare, or legal environments
• Proficiency in Microsoft Office (Word, Excel, Outlook) and general office technology
• Strong data entry skills with a high degree of accuracy

PREFERRED EDUCATION AND EXPERIENCE:

• Prior experience working for an insurance carrier or Third-Party Administrator (TPA)
• Familiarity with claims management systems and insurance terminology
• Experience handling confidential or regulated information (HIPAA, PII, etc.)
• Workers’ compensation, liability, or health insurance claims exposure a plus
• Proficient in HealthPac software.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Ability to manage multiple tasks and meet deadlines in a fast-paced environment
• Excellent written and verbal communication skills
• Strong attention to detail and organizational skills

·         Basic understanding of clerical procedures and systems such as recordkeeping and filing.

·         Ability to work independently.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

• Prolonged periods of sitting at a desk and working on a computer.
• Must be able to lift up to 15 pounds at times.

Pay Details:

Candidates should be comfortable with an on-site presence to support collaboration, team leadership, and cross-functional partnership.

Why Join Us:

At Acrisure, we’re building more than a business, we’re building a community where people can grow, thrive, and make an impact. Our benefits are designed to support every dimension of your life, from your health and finances to your family and future.

Making a lasting impact on the communities it serves, Acrisure has pledged more than $22 million through its partnerships with Corewell Health Helen DeVos Children's Hospital in Grand Rapids, Michigan, UPMC Children's Hospital in Pittsburgh, Pennsylvania and Blythedale Children's Hospital in Valhalla, New York.

Employee Benefits

We also offer our employees a comprehensive suite of benefits and perks, including:

• Physical Wellness: Comprehensive medical insurance, dental insurance, and vision insurance; life and disability insurance; fertility benefits; wellness resources; and paid sick time.

• Mental Wellness: Generous paid time off and holidays; Employee Assistance Program (EAP); and a complimentary Calm app subscription.

• Financial Wellness: Immediate vesting in a 401(k) plan; Health Savings Account (HSA) and Flexible Spending Account (FSA) options; commuter benefits; and employee discount programs.

• Family Care: Paid maternity leave and paid paternity leave (including for adoptive parents); legal plan options; and pet insurance coverage.

• … and so much more!

This list is not exhaustive of all available benefits. Eligibility and waiting periods may apply to certain offerings. Benefits may vary based on subsidiary entity and geographic location.

Acrisure is an Equal Opportunity Employer. We consider qualified applicants without regard to race, color, religion, sex, national origin, disability, or protected veteran status. Applicants may request reasonable accommodation by contacting leaves@acrisure.com.

Final candidates will be required to complete post-offer verification processes related to the role and in accordance with applicable laws.

California Residents: Learn more about our privacy practices for applicants by visiting the Acrisure California Applicant Privacy Policy.

Recruitment Fraud: Please visit here to learn more about our Recruitment Fraud Notice.

Welcome, your new opportunity awaits you.