Appeals Specialist

5 days ago


Temple, Texas, United States Baylor Scott & White Health Full time
About the Role

We are seeking a highly skilled Appeals Specialist to join our team in the Appeals and Grievances Department.

In this role, you will be responsible for intake into the department, including verbal and written complaints, grievances and requests for appeals that involve complex matters submitted by Members and Providers.

You will perform comprehensive research to clarify facts and circumstances in order to accept cases into inventory and maintain required documentation to assure meeting regulatory requirements on intake processes.

You will also communicate with members and providers verbally and in writing, track information to facilitate and expedite processing of appeals received, and assist with audit preparation as needed by management.

As an Appeals Specialist, you will be responsible for ensuring compliance with applicable policies and procedures and other governing bodies.

This is a challenging and rewarding role that requires strong analytical and communication skills, as well as the ability to work effectively in a fast-paced environment.

If you are a detail-oriented and organized individual who is passionate about providing excellent customer service, we encourage you to apply for this exciting opportunity.

Responsibilities:

  • Perform intake functions for the Appeals and Grievances Department, including verbal and written complaints, grievances and requests for appeals.

  • Conduct comprehensive research to clarify facts and circumstances in order to accept cases into inventory.

  • Maintain required documentation to assure meeting regulatory requirements on intake processes.

  • Communicate with members and providers verbally and in writing.

  • Track information to facilitate and expedite processing of appeals received.

  • Assist with audit preparation as needed by management.



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