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Appeals Specialist (Work-at-Home Option)
at Sedgwick CMS in Maine
Appeals Specialist
CLAIM YOUR FUTURE AS A GREAT PERFORMER!
Continuing double-digit revenue growth rates and progressive employment practices make Sedgwick Claims Management Services the place where great people can do great things for clients while maximizing their career possibilities. We have earned a reputation for innovation, quality, sustained growth, financial stability and a colleague-friendly work environment. We are proud to have been voted the Best TPA in America for 2005 and 2006, and the first and only Third Party Administrator to receive the coveted Employer of Choice designation. Come be a part of our team and "Claim Your Future."
PRIMARY PURPOSE:
To facilitate the denied disability (short-term, long-term and accident) claim appeal review process by observing all aspects of the ERISA law; and to serve as the liaison between the review unit and the claims operation.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Gathers and reviews denied disability claim appeal documentation including, but not limited to, appeal request letters, medical documentation, medical consultant reviews, surveillance reports, independent medical evaluation reports and functional capacity evaluation reports.
Reviews medical documentation and provides clinical and claim expertise on appealed claims.
Prepares written response to appeal request letters within the legislative timeframes.
Prepares appropriate communication to client and claim operation summarizing the appeal review determination.
Monitors and tracks the number of appealed claims.
Provides training to the claim operation regarding the claim appeal process.
Ensures integrity of the claim appeal process and ensures compliance with ERISA legislation.
Adheres to the highest quality and ethical standards when reviewing appealed claims and making determinations.
Supports the organization's quality program(s).
QUALIFICATIONS
Education & Licensing
Baccalaureate degree from an accredited college or university preferred. Licenses as required.
Experience
Six (6) years of related technical claims management experience required. Related field specialty experience is preferred.
Skills & Knowledge
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Analytical and interpretive skills
Strong organizational skills
Excellent interpersonal skills
Excellent negotiation skills
Ability to work in a team environment
Ability to meet or exceed Performance Competencies
WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding, travel as required
Auditory/Visual: Hearing, vision and talking
NOTE: Credit security clearance, confirmed via a background credit check, is required for this position.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
Sedgwick CMS is an Equal Opportunity Employer
and a
Drug-Free Workplace
Work-at-Home option may be available for strong and experienced candidates. This option remains at the sole discretion of Sedgwick CMS. There may also be options to work from various other Sedgwick CMS office locations.
How to apply: DO NOT use the Apply Online button. Please copy and paste the following link into your browser address bar:
http://sedgwickcms.contacthr.com/18361774
CLAIM YOUR FUTURE AS A GREAT PERFORMER!
Continuing double-digit revenue growth rates and progressive employment practices make Sedgwick Claims Management Services the place where great people can do great things for clients while maximizing their career possibilities. We have earned a reputation for innovation, quality, sustained growth, financial stability and a colleague-friendly work environment. We are proud to have been voted the Best TPA in America for 2005 and 2006, and the first and only Third Party Administrator to receive the coveted Employer of Choice designation. Come be a part of our team and "Claim Your Future."
PRIMARY PURPOSE:
To facilitate the denied disability (short-term, long-term and accident) claim appeal review process by observing all aspects of the ERISA law; and to serve as the liaison between the review unit and the claims operation.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Gathers and reviews denied disability claim appeal documentation including, but not limited to, appeal request letters, medical documentation, medical consultant reviews, surveillance reports, independent medical evaluation reports and functional capacity evaluation reports.
Reviews medical documentation and provides clinical and claim expertise on appealed claims.
Prepares written response to appeal request letters within the legislative timeframes.
Prepares appropriate communication to client and claim operation summarizing the appeal review determination.
Monitors and tracks the number of appealed claims.
Provides training to the claim operation regarding the claim appeal process.
Ensures integrity of the claim appeal process and ensures compliance with ERISA legislation.
Adheres to the highest quality and ethical standards when reviewing appealed claims and making determinations.
Supports the organization's quality program(s).
QUALIFICATIONS
Education & Licensing
Baccalaureate degree from an accredited college or university preferred. Licenses as required.
Experience
Six (6) years of related technical claims management experience required. Related field specialty experience is preferred.
Skills & Knowledge
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Analytical and interpretive skills
Strong organizational skills
Excellent interpersonal skills
Excellent negotiation skills
Ability to work in a team environment
Ability to meet or exceed Performance Competencies
WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding, travel as required
Auditory/Visual: Hearing, vision and talking
NOTE: Credit security clearance, confirmed via a background credit check, is required for this position.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
Sedgwick CMS is an Equal Opportunity Employer
and a
Drug-Free Workplace
Work-at-Home option may be available for strong and experienced candidates. This option remains at the sole discretion of Sedgwick CMS. There may also be options to work from various other Sedgwick CMS office locations.
How to apply: DO NOT use the Apply Online button. Please copy and paste the following link into your browser address bar:
http://sedgwickcms.contacthr.com/18361774
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Published on Jan 21, 2011
Viewed: 858 times
Viewed: 858 times
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