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Appeals Specialist

4 months ago

Remote, Oregon, United States VirginPulse Full time

Now is the time to join us

Virgin Pulse and HealthComp are now Personify Health. The industry's first personalized health platform company combines health, wellbeing, and navigation solutions to deliver powerful outcomes to businesses and their people. At Personify Health, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we're shaping a healthier, more engaged future.


Who are you?

The Appeals Specialist is responsible for timely processing of grievances, appeals and provider claim disputes in compliance with all Federal and State laws. This position handles all aspects of grievances, appeals, and complaints.

In this role you will wear many hats, but your knowledge will be essential in the following:

  • Reviews all incoming documents to determine appropriate action required.
  • Researches and responds to internal appeals within regulatory timeframes.
  • Maintains knowledge of government regulations as they pertain to appeals, claims payments, and generally recognized claims standards.
  • Drafts response letters to members/patients or providers, communicates with applicable departments, and files all documentation.
  • Organizes work and work-flow so that performance standards and procedures for appeals resolution are consistent with client, state and federal requirements.

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.


What you bring to the Personify Health team:

In order to represent the best of what we have to offer you come to us with a multitude of positive attributes including:

  • High school diploma or general education degree (GED).
  • Basic Knowledge of provider billing preferred.
  • Minimum one (1) year related experience and/or training; or equivalent combination of education and experience.
  • Direct medical claims experience.

You also take pride in offering the following Core Skills, Competencies, and Characteristics:

  • Demonstrated self-motivation, organizational skills, and problem-solving skills.
  • Strong written and oral communication skills with attention to detail and accuracy.
  • Requires excellent research and investigative skill.
  • Demonstrated knowledge of Microsoft Office suite.

No candidate will meet every single desired qualification. If your experience looks a little different from what we've identified and you think you can bring value to the role, we'd love to learn more about you

Personify Health is an equal opportunity organization and is committed to diversity, inclusion, equity, and social justice.

In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges from $ $25.00 hourly. Note that salary may vary based on location, skills, and experience. This position is eligible for health, dental, vision, mental health and other benefits.

#LI-REMOTE