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Appeals Specialist

4 months ago

Anderson, United States Unified Group Services Inc Full time
Job DescriptionJob Description

Unified Group Services is a full-service third-party administrator (TPA) for self-insured group health plans. We're dedicated to providing excellent customer service and the flexibility our customers desire in administering employee benefit plans.

Unified Group Services has a reputation for excellent customer service in the marketplace, and this position is crucial to continuing that status.

Appeals may be submitted by providers and/or their representatives, members, attorneys, and sometimes a PPO (Preferred Provider Organization) may request a review.

JOB DESCRIPTION:

  • Research internal/external appeal (benefit determination, Usual and customary reduction, discount dispute, eligibility).
  • Work with internal review vendors on internal appeals and independent review organizations (IRO) on external reviews. This essential team review requires the employee to work inside the office.
  • Work with our clients, reinsurance department, subrogation department, case management/pre-cert vendors, PPOs on occasion
  • Draft letters in response to appeal (providers, provider representatives, members, occasionally an attorney)
  • Adhere to plan timeframes regarding all aspects of appeals
  • As with any job, there may be other tasks assigned as necessary.

JOB QUALIFICATIONS:

  • High School Diploma or GED. Some college is helpful but not required
  • Working knowledge of Microsoft Word, Excel, and Outlook is required
  • Strong math skills.
  • Attention to detail and the ability to meet deadlines are critical to success.
  • Professional phone communication skills.
  • Good organizational skills and excellent customer service.
  • Good writing skills, using proper grammar, punctuation, and sentence structure.
  • Problem-solving and decision-making skills are vital
  • Self-motivated & self-starter with a willingness to learn.
  • Excellent attendance.

PAY BASIS: Hourly

Hours are Monday through Friday, 8:00 a.m. to 5:00 p.m.

BENEFITS:

Unified Group offers an excellent benefits package including:

  • Medical, dental, and vision insurance
  • Matching 401K plan
  • Life insurance
  • Short and Long-term disability
  • Student loan debt payments
  • Vacation and PTO time
  • Health Clinic
  • Sponsored wellness plans.

OTHER REASONS TO WORK HERE:

  • Family-oriented, positive work environment
  • Weekends off
  • Voluntary overtime during peak season
  • Recently voted one of the Best Places to Work in Indiana


This is an in-the-office position. We are located just off I-69, exit 226.

Unified Group Services is an Equal Opportunity Employer.