Appeals Review Specialist
virtual vocationsDenver, CO
Appeals Review Specialist
L5
virtual vocationsDenver, COtoday
Occupations
Insurance Claims and Policy Processing ClerksClaims Adjusters, Examiners, and InvestigatorsRegulatory Affairs SpecialistsIndustries
Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension FundsAll Other Insurance Related ActivitiesDirect Health and Medical Insurance CarriersWorking remotely on a full-time salaried basis, the Appeals Review Specialist will review claims for accuracy, respond to inquiries from members and providers, and ensure compliance with regulatory standards while maintaining quality assurance in claims processing.
Key responsibilities:
Verify claim accuracy against medical records and review for fraud and abuse
Respond to member and provider inquiries regarding claim denials and provide denial explanations
Participate in quality assurance initiatives and collaborate with cross-departmental teams to improve processes
Required qualifications:
High school diploma or equivalent
Minimum of two years of experience in healthcare claims examining or related work
Proficient in Microsoft Office and possess strong typing skills
Ability to maintain neutrality and confidentiality in all interactions
Demonstrated organizational and self-motivation skills
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Level
SeniorL5
Location
Denver, CO
Occupation
Insurance Claims and Policy Processing Clerks
Industry
Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds
Posted
today
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