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Appeals Analyst - GP
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Job Description
- Req#: 2019-9365
Employer Industry: Healthcare Insurance
Why consider this job opportunity:
- Salary up to $83,160
- Comprehensive health benefits, including Medical, Dental, and Vision
- Generous Paid Time Off (PTO) and incentive plans
- Opportunities for professional development with tuition reimbursement
- Supportive work environment with wellness programs and paid volunteer time off
- Chance to mentor and develop less experienced staff while advancing in your career
What to Expect (Job Responsibilities):
- Present cases at Leadership Appeals Workgroup hearings, explaining denials and coverage scope
- Conduct comprehensive fact-gathering by contacting relevant areas of the company
- Authorize administrative exceptions and conduct daily image queue reviews
- Identify training opportunities to reduce appeals and enhance employee performance
- Assist in developing new staff through mentoring and coaching on appeal handling
What is Required (Qualifications):
- High School Diploma or GED required; 5 years of equivalent relevant work experience in lieu of a degree
- Minimum of seven years of business experience, including four years in customer service
- Healthcare industry experience is required, with a focus on complex claims processing
- Knowledge of insurance claim and membership systems, along with medical terminology
- Proficiency in Microsoft Office Suite is required
How to Stand Out (Preferred Qualifications):
- Prior experience handling appeals preferred
- Familiarity with HBCBSNJ complaints and appeals process
- Knowledge of COB and Medicare procedures
- Experience with UCSW is a plus
- Strong investigative and analytical skills
#HealthcareInsurance #CareerOpportunity #CompetitivePay #ProfessionalDevelopment #Mentoring
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