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Appeals Specialist
Devoted Health. Correspond with members and/or providers through written communication and telephone contact, with appropriate documentation .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managing appeals processes, including investigation and resolution, while maintaining compliance and data integrity. Strong communication skills are essential for effectively conveying product and policy information to members and providers.
Highest-signal resume keywords
Bachelor's Degree In Health CareAppeals ManagementData Entry And DocumentationCustomer Service SkillsInsurance Products Knowledge
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Data IntegrityAnalytical SkillsDocumentation SkillsInvestigation SkillsConflict Resolution
Soft Skills
Oral Communication SkillsWritten Communication SkillsDetail OrientedInterpersonal SkillsProblem-Solving Skills
Industry Keywords
Health CareInsurance PoliciesClaims ProcessCMS Universe DetailsDevoted Health Products
About the role
Key responsibilities & impact- Correspond with members and/or providers through written communication and telephone contact, with appropriate documentation
- Coordinate with managers, internal departments, and external vendors to investigate, review, and resolve appeals
- Research cases and prepare them for internal or external review
- Manage the receipt, investigation, and resolution of appeals in a timely, compliant, and effective manner
- Maintain current knowledge of Devoted Health products, policies, and procedures
- Explain product, policy, and procedure information clearly to members, providers, and other individuals
- Complete data entry and documentation in multiple systems to capture required CMS universe details
Requirements
What you’ll need- Strong computer, analytical, oral and written communication skills
- Bachelor’s degree or equivalent experience in health care, conflict resolution, or related field
- Detail oriented; data integrity and documentation are very important
- Superior investigation, customer service, interpersonal, and problem-solving skills
- Working knowledge of insurance products, policies, procedures, and claims process
Benefits
Comp & perks- Employer sponsored health, dental and vision plan with low or no premium
- Generous paid time off
- $100 monthly mobile or internet stipend
- Stock options for all employees
- Bonus eligibility for all roles excluding Director and above
- Commission eligibility for Sales roles
- Parental leave program
- 401K program