Appeals Specialist
Appeals Specialist
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Job Description
Unified Group Services is a fullservice thirdparty administrator (TPA) for selfinsured group health plans. Were dedicated to providing excellent customer service and the flexibility our customers desire in administering employee benefit plans.
Unified Group Services has a reputation for excellent customer service in the marketplace and this position is crucial to continuing that status.
Appeals may be submitted by providers and/or their representatives members attorneys and sometimes a PPO (Preferred Provider Organization) may request a review.
JOB DESCRIPTION:
- Research internal/external appeal (benefit determination Usual and customary reduction discount dispute eligibility).
- Work with internal review vendors on internal appeals and independent review organizations (IRO) on external reviews. This essential team review requires the employee to work inside the office.
- Work with our clients reinsurance department subrogation department case management/precert vendors PPOs on occasion
- Draft letters in response to appeal (providers provider representatives members occasionally an attorney)
- Adhere to plan timeframes regarding all aspects of appeals
- As with any job there may be other tasks assigned as necessary.
JOB QUALIFICATIONS:
- High School Diploma or GED. Some college is helpful but not required
- Working knowledge of Microsoft Word Excel and Outlook is required
- Strong math skills.
- Attention to detail and the ability to meet deadlines are critical to success.
- Professional phone communication skills.
- Good organizational skills and excellent customer service.
- Good writing skills using proper grammar punctuation and sentence structure.
- Problemsolving and decisionmaking skills are vital
- Selfmotivated & selfstarter with a willingness to learn.
- Excellent attendance.
PAY BASIS: Hourly
Hours are Monday through Friday 8:00 a.m. to 5:00 p.m.
BENEFITS:
Unified Group offers an excellent benefits package including:
- Medical dental and vision insurance
- Matching 401K plan
- Life insurance
- Short and Longterm disability
- Student loan debt payments
- Vacation and PTO time
- Health Clinic
- Sponsored wellness plans.
OTHER REASONS TO WORK HERE:
- Familyoriented positive work environment
- Weekends off
- Voluntary overtime during peak season
- Recently voted one of the Top Workplaces in Indiana!
This is an intheoffice position. We are located just off I69 exit 226.
Unified Group Services is an Equal Opportunity Employer.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
