- Remote, United States
- Remote
- Full-time · Mid
Responsible for reviewing, investigating, and resolving member appeals and provider disputes for benefit plans, ensuring accurate, timely, and compliant determinations in accordance with plan documents, employer-specific requirements, and applicable federal and state regulations.
Responsibilities
- Manage Appeals & Disputes
- Interpret Plans & Analyze Claims
- Ensure Compliance & Maintain Documentation
- Resolve Complex Cases & Escalate Risks
- Support Audits & Regulatory Reviews
Requirements
- Nice to have: self-funded plans
- Nice to have: level-funded plans
- Nice to have: process improvement
- Nice to have: appeals workflow optimization