Appeals Specialist

Contract: Phoenix, Arizona, US

Salary: $20.00 Per Hour

Job Code: 349594

End Date: 2024-06-20

Days Left: 6 days, 16 hours left

PR:$19/hr -$20/hr

About the Role:

  • We are looking for a dedicated individual to join our team at  Phoenix, AZ office as a Case Processor.
  • The primary responsibility of this role will be processing A&G cases, as well as handling mail duties.


  • Review and resolve member and provider complaints in accordance with CMS standards
  • Research and resolve appeals, disputes, grievances, and complaints from client members, providers, and outside agencies
  • Review claims appeals and grievances using support systems to determine outcomes
  • Request and review medical records, notes, and bills to formulate conclusions
  • Contact members/providers through written and verbal communication
  • Prepare appeal summaries, correspondence, and document findings
  • Compose all correspondence accurately and in accordance with regulatory requirements 
  • Research claims processing guidelines, provider contracts, fee schedules, and system configurations
  • Resolve and prepare responses to provider reconsideration requests and requests for claim adjustments

Education Qualification:

  • High School Diploma or equivalency

Required Skills: 

  • Minimum 2 years of operational managed care experience
  • Health claims processing background
  • Familiarity with claims denials and appeals processing
  • Strong verbal and written communication skills
Job Requirement
  • claims denials
  • appeals processing
  • resolve appeals
  • medical records
Reach Out to a Recruiter
  • Recruiter
  • Email
  • Phone
  • Srujan R
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