Appeals Specialist

Job description

Job Description A bit about this role: The Appeals Specialist is an integral part of our Appeals Operations team & our overarching Provider Escalations & Educations team. The Appeals Specialist is responsible for the timely processing & effective decision making on Appeals received from plan Providers, Non-Contracted Providers, & our Members or their appointed representatives. This individual will work cross functionally with areas such as Clinical, Medical Directors, UM, & claims to ensure we’re making appropriate decisions on our appeal reviews. Your Responsibilities and Impact will include: Correspond with members and/or providers as required (i.e., written communication and telephone contact along with documentation as appropriate) Coordinate with Managers, internal departments and external vendors relative to the investigation, review, and resolution of an appeal and the research needed to prepare the case for internal or external review Manage the receipt, investigation, and resolution of appeals in a timely, compliant, and highly effective manner Maintain a current knowledge of Devoted Health products, policies and procedures with the ability to relate this information in a clear, concise and understandable manner to members, providers, and other individuals, both internal and external Complete data entry and documentation requirements in multiple systems to ensure required CMS universe details are captured appropriately Required skills and experience: Strong computer, analytical, oral and written communication skills Bachelor’s degree or equivalent experience in health care, conflict resolution, or related field Detail oriented - the data integrity is very important in this role and all of the documentation that goes with it Desired skills and experience: Superior investigation, customer service, interpersonal, and problem-solving skills Working knowledge of insurance products, policies, procedures, claims process #LI-Remote Salary range: $23-$30 per hour The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job. Our Total Rewards package includes: Employer sponsored health, dental and vision plan with low or no premium Generous paid time off $100 monthly mobile or internet stipend Stock options for all employees Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles Parental leave program 401K program And more.... *Our total rewards package is for full time employees only. Intern and Contract positions are not eligible. Founded in 2017, Devoted Health is on a mission to dramatically improve the health and well-being of older Americans by caring for everyone like they are family, and that includes our employees. Our robust and seamlessly integrated care platform merges advanced data and AI access with world-class clinical and service experiences to create a member experience that is unlike the industry norm. To continue building upon our mission, we want to bring together those who share our values, embrace change and advancement, and are enthusiastic about where we're going — all the while bringing their own unique qualities, experiences, and expertise, in hopes of further changing the healthcare experience. Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business. As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.