Our client is looking for an experienced Medicare and US Family Health Plan (USFHP) Appeals Specialist.

If the following describes you, your experience, knowledge, and education, apply today!

• Excellent written and verbal communication skills.
• Effective time management skills and organizational skills.
• Strong interpersonal skills and the ability to collaborate with internal and external clients.
• Strong organizational skills, having the ability to meet deadlines.
• Ability to handle confidential and sensitive information in a discreet and professional manner.

Self-driven and self-motivated, having the ability to function independently with sound decision making.

Experience/Knowledge: Preparing appeals documentation within contractual and regulatory requirements.

Experience/Knowledge:  Evaluating medical claims and coverage policies documentation to determine validity of the appeal.

Experience/Knowledge:  Preparing case files on clinical members and provider appeals for review by clinical team members.

Experience/Knowledge: Preparing and sending appeal case files for all appeal levels in accordance with regulatory requirements.

Experience/Knowledge: Conducting telephone work with members, providers, and third-party administrators.

Experience/Knowledge: Microsoft Office applications (Word, Excel, PowerPoint)

Education/Experience: 

Bachelor’s Degree or equivalent experience and education. 3+ years of experience in managed care plan required. 

If you meet the above and would like to learn more about this exciting opportunity, and the great benefits it offers, apply today, and interview tomorrow! HW Staffing will be your partner in career navigation, supporting you from the moment you apply on through to hire, and thereafter!