State Licensed Appeals Specialist

A company is looking for an Appeals Specialist to manage appeals reviews and ensure compliance with regulatory guidelines. Key Responsibilities Review and develop action plans for appealed claims in accordance with policy provisions Resolve appeals in a timely manner and communicate outcomes to relevant parties Conduct claim audits and analyze data to identify trends and compliance issues Required Qualifications Minimum of 5 years of experience in managing claim appeals and audits Strong knowledge of ERISA, HIPAA, and relevant insurance laws Expertise in Short Term Disability, Long Term Disability, Life, and Waiver of Premium claims processing Bachelor's degree preferred; high school diploma required State licensing as required by the company

Mar 28, 2025 - 20:15

A company is looking for an Appeals Specialist to manage appeals reviews and ensure compliance with regulatory guidelines. Key Responsibilities Review and develop action plans for appealed claims in accordance with policy provisions Resolve appeals in a timely manner and communicate outcomes to relevant parties Conduct claim audits and analyze data to identify trends and compliance issues Required Qualifications Minimum of 5 years of experience in managing claim appeals and audits Strong knowledge of ERISA, HIPAA, and relevant insurance laws Expertise in Short Term Disability, Long Term Disability, Life, and Waiver of Premium claims processing Bachelor's degree preferred; high school diploma required State licensing as required by the company