Appeals Specialist II

2 months ago

Remote, Oregon, United States Healthcare Management Administrators (HMA) Full time

HMA is the premier third-party health plan administrator across the PNW and beyond. We relentlessly deliver on our promise to provide medium to large-size employers with customized health plans. We offer various high-quality, affordable healthcare plan options supported with best-in-class customer service.
We are proud to say that for three years, HMA has been chosen as a 'Washington's Best Workplaces' by our Staff and PSBJTM. Our vision, 'Proving What's Possible in HealthcareTM,' and our values, People First, Be Extraordinary, Work Courageously, Own It, and Win Together, shape our culture, influence our decisions, and drive our results.
What we are looking for: We are always searching for unique people to add to our team. We only hire people that care deeply about others, thrive in evolving environments, gain satisfaction from being part of a team, are motivated by tackling complex challenges, are courageous enough to share ideas, action-oriented, resilient, and results-driven.
What you can expect: You can expect an inclusive, flexible, and fun culture, comprehensive salary, pay transparency, benefits, and time off package with plenty of personal development and growth opportunities. If you are looking for meaningful work, a clear purpose, high standards, work/life balance, and the ability to contribute to something important, find out more about us at:
How YOU will make a Difference:
This role will use critical thinking skills to each unique appeal or reconsideration request and craft, edit and finalize precise and accurate written communication in the form of letters and client facing communication. This position will conduct outreach regarding appeal status, determinations and explanations with a high of confidence and accuracy. In addition, the Appeals Specialist, Lead will work as a team leader and educate and coach the team as needed as well as oversee the day to day operations, communication and case processing determinations.
What YOU will do:

  • Monitor and track the status of submitted appeals, ensuring timely follow-up and resolution.
  • Ensure that the TATs are being met on all of the appeals for member and providers
  • Review and analyze denied claims to determine the basis for denial and assess the potential for a successful appeal.
  • Liaise with healthcare providers, patients, and insurance representatives to collect additional information or clarification needed for appeals.

Knowledge, Experience, and Key Attributes needed for Success:

  • High School Diploma Required
  • 1-3+ years' previous experience with claims appeals and processing
  • Excellent written and verbal communications and the ability to convey important details and information
  • Proven ability to work independently and stay focused and motivated
  • High attention to detail

Compensation The base salary range for this position in the greater Seattle area is $29/hr - $37/hr for a level I and varies dependent on geography, skills, experience, education, and other job or market-related factors. While we are looking for level I, we may consider level II for highly qualified candidates. In addition, HMA provides a generous total rewards package for full-time employees that includes: seventeen (IC) days paid time off; eleven paid holidays, one paid personal and one paid volunteer day; company-subsidized medical, dental, vision, and prescription insurance; company-paid disability, life, and AD&D insurances; voluntary life insurances; HSA and FSA pre-tax programs; 401(k)-retirement plan with company match; wellness incentive and reimbursement; remote work and continuing education reimbursements; discount program; parental leave; and a charitable giving match. For more information about HMA, visit .
Disclaimer: The salary, other compensation, and benefits information are accurate as of this posting date. HMA reserves the right to modify this information at any time, subject to applicable law.
How we Support your Work, Life, and Wellness Goals
We offer a comprehensive total rewards package including: competitive pay; annual incentive; wellness programs; medical, dental, and vision insurance; 401K retirement plan with match; generous PTO and holidays; an onsite gym; life, AD&D, short and long-term disability insurances; an Employee Assistance Plan with additional mental health support; free parking and easy freeway access to I-405 and I-520; a stocked kitchen on-site with subsidized snacks and refreshments; year-round wellness activities; monthly events; paid volunteer hours and more
HMA is primarily a remote workforce, requires a reliable internet connection, and provides all hardware. Some roles are required onsite 1-3 days per week/month while other roles are 100% remote.
A background screen prior to employment is required.
Protected Health Information (PHI) Access Healthcare Management Administrators (HMA) employees may encounter protected health information (PHI) in the regular course of their work. All PHI shall be used and disclosed on a need-to-know-basis and according to HMA's standard policies and procedures.
HMA is an Equal Opportunity Employer

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