Appeals Resolution Analyst

Job not on LinkedIn

🔥 0 minutes ago

🦌 Connecticut, New Jersey, +2 more states – Remote

🦌 Connecticut – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🔔 Pennsylvania – Remote

💵 $44.6k - $59.7k / year

⏰ Full Time

🟢 Junior

🧐 Analyst

🚫👨‍🎓 No degree required

👻 Ghost score 20%

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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Horizon Connect @ Wall BCBSNJ

WebsiteLinkedInAll Job Openings

2 - 10 employees

⚕️ Healthcare Insurance

🏥 Healthcare

Healthcare Insurance • Healthcare

Horizon Connect @ Wall BCBSNJ is a LinkedIn presence or local program/office associated with Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ). Based on the name and context, it appears to be connected to Horizon BCBSNJ’s health insurance operations and local outreach or member/provider engagement in the Wall, NJ area. Publicly available information provided is limited and mostly LinkedIn site chrome rather than a company profile, so this description is conservative and based on the affiliation indicated by the name.

📋 Description

• Manage the end-to-end appeals process, including receiving appeals, entering data into the medical management system, facilitating external vendor review, and completing cases timely. • Speak with providers and members about the appeal process and appeal status. • Answer and triage the appeal Hotline phone queue. • Collaborate with internal and external vendors to process appeals according to NCQA, DOBI, State, and other regulatory standards. • Update authorizations based on appeal outcomes and ensure claims are effectuated timely. • Collaborate with internal customers to ensure notification of appeal outcomes. • Perform testing and projects to meet departmental goals. • Resolve basic clinical appeals for Government Programs under supervision while meeting timeliness and accuracy standards.

🎯 Requirements

• Requires a High School diploma or GED. • Bachelor's degree from an accredited college or university preferred. • Prefer a minimum of one (1) year recent acute care medical-surgical or rehabilitation experience. • Prefer one (1) year utilization management experience. • Requires knowledge of health care delivery systems. • Requires knowledge of CPT-4 and ICD-9 coding. • Requires knowledge of medical terminology. • Healthcare insurance experience preferred. • Requires strong oral and written communication skills. • Requires strong analytical and logical thinking. • Requires use of good grammar, diction and articulation. • Prefer ability to type 25 wpm. • Experience with Current Medical Management Systems preferred.

🏖️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • Paid Volunteer Time Off • Tuition Reimbursement