Appeals Specialist

2 weeks ago


Sandton, South Africa HR Studio Ltd Full time

Job Title: Appeals Specialist

We are seeking an experienced Appeals Specialist to join our team at HR Studio Ltd. As an Appeals Specialist, you will be responsible for analyzing and resolving verbal and written claims and authorization appeals through coordination with providers and members.

Key Responsibilities:

  • Utilize guidelines and tools to conduct research and analyze appeal issues and relevant claims.
  • Collect, analyze, and report verbal and written complaints and appeals from members and providers.
  • Analyze and make determinations on assigned appeal issues.
  • Draft response letters for member and provider appeals.
  • Maintain detailed records of all complaints, resolutions, and documentation for tracking and auditing purposes.

Requirements:

  • Matric Diploma or equivalent; associates degree preferred.
  • 2 years grievance and appeals, claims or related healthcare experience, preferably in a carrier or TPA setting.
  • Familiarity with CMS standards and requirements related to complaint resolution.
  • Proficient in Microsoft Office.

What We Offer:

  • A 3-6 week training program to equip you with the necessary skills and knowledge.
  • A supportive team environment that encourages growth and development.
  • The opportunity to make a meaningful contribution to our organization.

Contact Information: Please email your resume and cover letter to [insert email address].


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