Claim Appeals Specialist – PACE

Job not on LinkedIn

🔥 58 minutes ago

🇺🇸 United States – Remote

💵 $50k - $60k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.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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The Phia Group, LLC

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2000

💼 Consulting

🏥 Healthcare

🛡️ Insurance

💰 Private Equity Round on 2018-09

Consulting • Healthcare • Insurance

The Phia Group, LLC is a dedicated provider of healthcare cost containment solutions, focusing on empowering self-funded health plans to maximize benefits and minimize costs. Through a comprehensive suite of services, including subrogation and recovery, claims negotiation, and cost transparency initiatives, The Phia Group aims to help employers and families navigate the complexities of healthcare with advocacy and expertise. Their commitment to improving healthcare accessibility and affordability sets them apart in the industry.

📋 Description

• Maintain an inventory of required and received client documents • Coordinate and review employer benefit plan documents and stop loss policies • Communicate with clients regarding receipt and status of appeals • Receive, audit, and review submitted final internal medical claims appeals and external medical claims appeals • Prepare and summarize appeal content • Assign appeals for review and response • Create and coordinate timely status updates and responses to clients • Perform extensive computer work and operate office equipment including computers, copiers, and fax machines

🎯 Requirements

• Minimum of 2 years of experience with employer benefit plan documents and reviewing of medical appeals • Ability to utilize various case management software for tracking appeals • Excellent organizational skills and attention to detail • Excellent verbal and written communication skills • Advanced knowledge of Microsoft Excel • Ability to multitask with a high level of attention to detail • Ability to handle stressful situations and deadline pressures well • Ability to plan and carry out responsibilities with minimal direction • Ability to perform essential job functions unaided or with reasonable accommodation • Compliance with applicable citizenship and immigration-status employment practices

🏖️ Benefits

• Exceptional benefits for employees • Equal opportunity employment • Reasonable accommodation for qualified individuals with disabilities

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