Appeals Specialist

Job Description

Job Description

Appeals Specialist | $21.00-$25.00 per hour | Monday–Friday, 8AM–5PM | Fully On-site | Long-term Contract

What Matters Most:

• Competitive pay range of $21.00 - $25.00 per hour, based on work experience.
• Schedule: Monday–Friday, 8:00 AM to 5:00 PM
• Location: Houston, TX 77092 area
• Weekly pay with direct deposit or pay card
• When you work through Team1Medical, a Reserves Network company, you are eligible to enroll in dental, vision, and medical insurance as well as 401K, direct deposit, and our referral bonus program

Job Summary :
The Appeals Specialist is responsible for ensuring professional and compliant processing of all appeals, predetermination requests, consumer grievances, department of insurance inquiries, and legal inquiries in a timely and efficient way, in accordance with corporate and insurance regulatory standards

Responsibilities:

• Review and research appeal and complaints submitted on marketed health insurance policies.
• Correspond with policyholders and/or applicable third party as required (written acknowledgement and closure letters and telephone contact as appropriate).
• Complete data entry and documentation requirements in multiple systems.
• Act as a liaison and coordinate functions with internal departments relative to the status of an inquiry and the research needed.
• Interact with Claim Examiners, Claim Department Management, Company Officers, as well as our Legal Department, to resolve the inquiries that are received.
• Responsible for compliance with all regulatory and department timelines.
• Review predetermination requests and relevant medical records to determine patient eligibility and to provide benefit estimates to providers as requested

Qualifications and Requirements:

• Bachelor’s Degree in English, Business Administration, Government or Communications and/or related field.
• 1-3 years of working in a professional office setting.
• Effective interpersonal skills as well as excellent written and verbal communication skills are essential.
• Experience working with Microsoft Word, Excel, and SharePoint is preferred.
• Knowledge or certification of basic medical terminology is a plus.
• Experience with medical billing/coding is preferred.
• Knowledge or certification of CPT/HCPCS/ICD-9/ICD-10 coding is a plus.
• Prior experience handling predetermination requests, consumer appeals, or complaints is a plus.

Benefits and Perks:

• Pay range: $21.00-$25.00 DOE
• Medical, dental, and vision insurance options
• Training and growth opportunities
• Weekly pay and convenient location

Your New Organization:
Large Insurance company with Headquarters in Houston Texas. Provides a range of financial protection products, including Life insurance (term & whole), Annuities (retirement income products) and Supplemental health insurance

Your Career Partner:
The Reserves Network, a veteran-founded and family-owned company, specializes in connecting exceptional talent with rewarding opportunities. With extensive industry experience, we are dedicated to helping you achieve your professional goals and shine in your field. The Reserves Network values diversity and encourages applicants from all backgrounds to apply. As an equal-opportunity employer, we foster an environment of respect, integrity, and trust in every aspect of employment.

In the spirit of pay transparency, we want to share the base hourly pay rate for this position is $21.00 - $25.00 per hr, not including benefits, potential bonuses or additional compensation. If you are hired, your base salary will be determined based on factors such as individual skills, qualifications, experience, and geographic location. In addition, we also believe in the importance of pay equity and consider the internal equity of our current team members as a part of any final offer. Please keep in mind that the range mentioned above is the full base salary range for the role. Hiring at the maximum of the range would not be typical to allow for future & continued salary growth.

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