The Appeals Analyst reviews and responds to appeals and inquiries from members, providers, authorized representatives, insurance departments, and/or other regulatory bodies regarding adverse benefit determinations within the timeframes set forth in both federal and state law.
This position must favor neither the Company nor the member and must exercise independent judgment in determining whether an adverse benefit determination was legal, appropriate, impartial and in accordance with the enterprise's obligation under the applicable contract.
EXPERIENCE & KNOWLEDGE:
Minimum three (3) years' healthcare grievances, appeals, claims processing, claims research, customer service or related legal experience.
Working knowledge of insurance products, policies, procedures and/or claims processing preferred.
Experience using Microsoft Office i.e. Word and Excel.
ESSENTIAL ABILITIES:
Sound Judgement
HIPAA Confidentiality
Legal Confidentiality
Taking Initiative
Education:
Bachelor's degree in related field.
In lieu of degree, five (5) years' relevant experience will be considered in addition to the experience requirements listed below.
Numbers & Facts
Location
Little Rock, AR (Remote)
Salary
$27.58 Per Hour
Skills
Analysis Skillsunmatched
Claims Processingunmatched
Customer Support/Serviceunmatched
Federal Laws and Regulationsunmatched
HIPAA (Health Insurance Portability and Accountability Act)unmatched
Healthcareunmatched
Insuranceunmatched
Legalunmatched
Microsoft Excelunmatched
Microsoft Officeunmatched
Microsoft Wordunmatched
Regulationsunmatched
State Laws and Regulationsunmatched
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