Appeals Specialist

Position Summary

The Appeals Specialist will be responsible for reviewing member and provider appeals involving plan benefit disputes, attorney complaints, and department of insurance complaints for various blocks of business.

• Reviewing appeal and supporting documentation
• Reviewing Summary Plan Documents to determine validity of appeal
• Composing appeal response letters when necessary
• Communicating with other departments and clients when necessary
• Documenting the Qic Link system and database with appeal status and outcome
• Emailing claims examiners and other units when necessary
• Prioritize incoming referrals to complete all tasks timely
• Performs other related duties as assigned

• High School diploma or equivalent required

• 3 years or more of comprehensive experience with the billing of or otherwise handling of medical, dental and vision claims required.
• Applicant should be proficient in the use of the Excel and Word programs
• Experience with or ability to learn Microsoft Access
• Be able to communicate effectively both orally and by email
• Applicant must have the ability to analyze claim situations, take appropriate actions and be great with communication and documentation.
• Applicant must have a history of excellent quality results and the desire to take on a new challenge if currently employed at Allied.

• Communication
• Customer Focus
• Accountability
• Functional/Technical Job Skills

• This is a standard desk role – long periods of sitting and working on a computer are required.

• 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 100

Mbps download/25

Mbps 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 & 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.