Job DetailsJob Location: Allied Benefit Systems - CHICAGO, IL 60606Position Type: Full TimeSalary Range: $20.00 - $21.00 HourlyJob Category: Claims
POSITION SUMMARY:
The Appeals Specialist is responsible for monitoring and tracking the status of appeals as they relate to the Allied Advocate program. The position involves but is not limited to reviewing appeals for appropriateness, documenting the claim specifics into the current software and routing documentation to business partners for review/resolution. The Appeals Specialist also provides follow up with business partners on aging appeals. The Appeals Specialist requires a strong knowledge of medical claims processing. This position also coordinates with Allied business partners for documenting and tracking appeals.
ESSENTIAL FUNCTIONS:
Logging/tracking all appeals received
Reviewing appeal and supporting documentation
Reviewing Summary Plan Documents to determine validity of appeal
Composing appeal response when necessary
Communicating with other departments and the clients when necessary
Documenting the Qiclink system and database with appeal status and outcome
Coordinating appeal response with business partners
Prioritize incoming referrals to complete all tasks timely
Other duties as assigned
EDUCATION:
Bachelor’s degree or equivalent work experience required.
EXPERIENCE AND SKILLS:
2 years of comprehensive experience with the handling of medical claims appeals experience required.
Proficient with Microsoft Office Suite or related software required.
Ability to analyze claim situations and take appropriate actions.
Excellent verbal and written communication skills.
Strong analytical and problem-solving skills.
Excellent organizational skills and attention to detail.
Excellent time management skills with a proven ability to meet deadlines.
Ability to learn new systems.
POSITION COMPETENCIES:
Accountability
Communication
Customer Service Orientation
Functional/Technical Skills
Quality Focus
Time and Task Management
PHYSICAL DEMANDS:
This is standard desk role requiring extended periods of sitting and computer work.
WORK ENVIRONMENT:
Remote
Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive.
The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
Compensation is not limited to base salary. Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life and Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.
Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process. It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role.Qualifications