Allied Benefit Systems · 1 day ago

Appeals Specialist

United States

Full-time

Remote

Entry, Mid Level

2+ years exp

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Responsibilities

Independently review and analyze appeals related to Allied’s Cost Containment programs.

Review Summary Plan Documents to determine validity of appeals.

Review, analyze and add applicable notes to the QicLink System

Review/audit processed health care claims for accuracy.

Consult with other entities who can offer additional review of an appeal.

Respond timely and appropriately to inquiries related to the No Surprises Act, including Independent Dispute Resolution (IDR) and open negotiation requests.

Other duties as assigned.

Qualification

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ICD codesCPT codesHealthcare claims analysisMicrosoft Office

Required

High School Diploma

Knowledge of International Classification of Diseases (ICD) and/or Current Procedural Terminology (CPT) codes

Intermediate level work experience with Microsoft Office, Word, Excel, and Power Point applications

Ability to multi-task, this includes ability to understand multiple products, multiple levels of benefits within each product and work within multiple systems

Excellent verbal and written communication skills

Strong analytical and critical thinking skills

Excellent organizational skills and mindfulness

Excellent time management skills with a proven ability to meet deadlines

2-4 years’ experience analyzing healthcare claims (processing claims)