Description We are seeking an Appeals specialist to join our team in Anderson, Indiana. In this role, you will be responsible for managing internal and external appeals, collaborating with various departments, drafting response letters, and ensuring all tasks adhere to Plan timeframes. This role is vital in maintaining the integrity of our operations in the industry. Responsibilities: Conducting research on internal and external appeals, including benefit determination, Usual & Customary reduction, and discount disputes. Collaborating with internal review vendors on internal appeals and Independent review organizations (IRO) on external reviews. Interacting with clients, the reinsurance department, subrogation department, case management/precert vendors, and PPO’s as required. Drafting response letters to appeals from providers, provider representatives, members, or attorneys. Corresponding via phone calls and emails with claims processors, reinsurers, case management/precert vendors, providers, members, clients, and occasionally attorneys. Ensuring adherence to Plan timeframes in all aspects of appeal management. Performing other tasks as assigned, demonstrating flexibility and adaptability in a dynamic work environment. Utilizing skills such as ADP - Financial Services, ADP Workforce Now, Ceridian, Cisco Webex Meetings, CRM, Auditing, Benefit Functions, Claim Administration, Cobra Administration, and Communication. Requirements Understanding of auditing processes and procedures Knowledge of benefit functions and administration Experience in claim administration Excellent communication skills, both written and verbal.Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more.All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.© 2024 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking “Apply Now,” you’re agreeing to Robert Half’s Terms of Use (https://www.roberthalf.com/us/en/terms) .
