BusinessOperations - Appeals Specialist II

Job Description

Job Description

Immediate need for a talented BusinessOperations - Appeals Specialist II. This is a 06+months contract opportunity with long-term potential and is located in Houston City, TX(Onsite) . Please review the job description below and contact me ASAP if you are interested.

Job ID:26-30759

Pay Range: $23 /hour.  Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Support the documentation and processing of appeals, disputes, and reconsiderations.
• Perform data entry to track, log, and process appeals in accordance with regulatory guidelines.
• Prepare correspondence and maintain documentation files for appeals and disputes.
• Review and investigate requests to determine applicable follow-up actions.
• Conduct research to evaluate and respond to appeals, ensuring timely decisions.
• Prepare case files with supporting documentation for review and reporting.
• Gather data to track and report on trends and outcomes, conducting outreach as necessary.
• Comply with all policies and standards while performing other duties as assigned.

Key Requirements and Technology Experience:

• High School diploma or GED required.
• 1 – 2 years of related experience preferred.
• Knowledge of appeals, disputes, and reconsiderations process is a plus.

Our client is a leading Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, colour, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy here.

#prof