Appeals Review Specialist
virtual vocationsDenver, CO
Appeals Review Specialist
virtual vocationsDenver, COSenior L5
Insurance Claims and Policy Processing ClerksClaims Adjusters, Examiners, and InvestigatorsRegulatory Affairs Specialists
Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension FundsAll Other Insurance Related ActivitiesDirect Health and Medical Insurance Carriers
APPLY NOW (opens in a new tab)Working 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
Senior L5
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
2 days ago