Note: The job is a remote job and is open to candidates in USA. Amtex Systems Inc is hiring an Appeals Analyst to support healthcare insurance appeals and inquiries. The role reviews adverse benefit determinations, responds to members and other stakeholders, and independently evaluates whether determinations comply with applicable contracts and federal and state law.
Responsibilities
- The Appeals Analyst reviews and responds to appeals and inquiries from members, providers, authorized representatives, insurance departments, and/or other regulatory bodies regarding adverse benefit determinations within the timeframes set forth in both federal and state law. This position must favor neither the Company nor the member and must exercise independent judgment in determining whether an adverse benefit determination was legal, appropriate, impartial and in accordance with the enterprise’s obligation under the applicable contract
Skills
- Bachelor's degree in related field. In lieu of degree, five (5) years' relevant experience will be considered in addition to the experience requirements listed below
- Minimum three (3) years' healthcare grievances, appeals, claims processing, claims research, customer service or related legal experience
- Experience using Microsoft Office i.e. Word and Excel
- Sound Judgement
- HIPAA Confidentiality
- Legal Confidentiality
- Taking Initiative
- Working knowledge of insurance products, policies, procedures and/or claims processing preferred
Benefits
- Remote work
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