Quality Assurance Appeals Coordinator

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November 26

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Marpai Administrators LLC

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Healthcare Insurance • Fintech • Insurance

Marpai Administrators LLC is a cutting-edge technology-powered Third-Party Administrator (TPA) that specializes in supporting employers with self-funded health plans. The company focuses on reducing healthcare costs while enhancing the healthcare options available to employees and their families. They provide comprehensive health plan administration, including dental, vision, and COBRA benefits, alongside proactive care management solutions, making them a reliable partner for organizations aiming to improve their health insurance strategy and member care.

51 - 200 employees

Founded 2019

⚕️ Healthcare Insurance

💳 Fintech

📋 Description

• Case management: Receive, prioritize, and process incoming written and verbal appeal requests. • Investigation and Analysis: Conduct thorough investigations by gather and analyzing all necessary documentation, including medical records, claim details, and denial letters to undertand the full scope of the case. • Documentation: Accurately document all communications and case information in the appeals tracking database and case files, ensuring meticulous record-keeping. • Communication: Draft and prepare accurate, professional response letters and other client-facing communications to inform all involved parties of the appeal status and resolution. • Compliance: Ensure all appeal activities and correspondence meet established internal policies and external regulatory timeframes and standards. • Coordination: Collaborate with various internal departments to gather information, coordinate case reviews and ensure comprehensive support of each appeal. • Trend Reporting: Monitor appeal trends, identify root causes of denials and report findings to management to support process improvement initiatives.

🎯 Requirements

• High proficiency in MS Office Suite of products • 2+ years of experience in health insurance industry (preferably in claims and audit) • Preferred 2+ years claims processing, but not required • Work independently

🏖️ Benefits

• Generous PTO • Medical and Prescription • EAP • FSA / HSA / Dependent Care • Dental • Vision • Life and Disability • STD/LTD • Voluntary Benefits: Critical Illness, Accident, Hospital • 401k with Employer Match • LegalShield • Identity Theft Protection