Appeals Specialist

🔥 11 minutes ago

🗽 New York – Remote

🗽 New York – Remote

💵 $58.9k - $80.1k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 1%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Healthfirst

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1993

🛡️ Insurance

🏥 Healthcare

⚕️ Healthcare Insurance

Insurance • Healthcare • Healthcare Insurance

Healthfirst is a health insurance provider dedicated to helping New Yorkers access affordable health coverage for individuals and families. With over 30 years of experience, Healthfirst offers a range of plans including Medicaid managed care, Medicare Advantage, long-term care, and essential health plans. The company focuses on providing quality healthcare options, comprehensive benefits, and support to ensure members can maintain their health and well-being.

📋 Description

• Process member and non-contracted provider appeals for Healthfirst’s commercial, Medicaid, dual enrollment, Medicare and complete care lines of business • Develop and resolve non-clinical cases, including certain claim denials, member complaints, and member and provider appeals • Research issues and reference internal health plan policies and procedures • Interpret regulations and make critical case-resolution decisions • Edit and finalize resolution letters • Manage caseloads and duties within regulatory timeframes • Communicate with colleagues to hand off or pick up work • Prepare and submit documented appeals according to payer guidelines and timely filing limits • Identify denial patterns and trends and provide leadership feedback for process improvement • Stay current on payer policies, industry regulations and coding updates • Perform additional duties as assigned

🎯 Requirements

• HS Diploma or GED from an accredited institution • Minimum of two (2) years of work experience in Managed Care Health Insurance Plan • Experience with appeals for Medicare, Medicaid, Dual enrollment and commercial Plans end to end • Claims processing experience with coding criteria is preferred • Bachelor’s degree from an accredited institution or relevant work experience • Demonstrated critical thinking and decision-making competencies • Demonstrated ability to be detail oriented, work under pressure, manage tight timeframes • Must work Monday through Friday, 8am–5pm or 8:30am–5pm EST • Residence in an approved location; hiring range distinguishes Greater New York City Area (NY, NJ, CT residents) and other approved locations

🏖️ Benefits

• Medical, dental and vision coverage • Incentive and recognition programs • Life insurance • 401k contributions • Competitive compensation and benefits package