Appeals Specialist
4 weeks ago
Job Summary: We are seeking a highly skilled Appeals and Complaints Resolution Specialist to join our team at HR Studio Ltd.
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.
- Serve as a subject matter expert on appeals, ensuring accurate record-keeping and status updates on all appeals.
- Act as a liaison between members, providers, regulatory agencies, and internal teams; coordinate with key individuals regarding appeal decisions.
- Work with internal subject matter experts to obtain benefit and/or clinical opinions and interpretations of complex cases.
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.
- Maintain confidentiality and exercise discretion in handling sensitive information.
-
Appeals Specialist
4 weeks ago
Sandton, South Africa HR Studio Ltd Full timeJob Title: Appeals SpecialistWe 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...
-
Appeals Specialist
4 weeks ago
Sandton, South Africa HR Studio Full timeWe're seeking a skilled Appeals Specialist to join our team at HR Studio.This role involves analyzing and resolving verbal and written claims and authorization appeals through coordination with providers and members.You will be responsible for:Utilizing guidelines and tools to conduct research and analyze appeal issues and relevant claims.Collecting,...
-
Appeals Specialist
4 weeks ago
Sandton, South Africa HR Studio Ltd Full timeWe are seeking a highly skilled Appeals Specialist to join our team at HR Studio Ltd. This role is responsible for analyzing and resolving verbal and written claims and authorization appeals through coordination with providers and members.The ideal candidate will have the ability to communicate clearly and professionally with internal and external customers,...
-
Appeals Resolution Specialist
4 weeks ago
Sandton, South Africa HR Studio Full timeWe're seeking an Appeals Resolution Specialist to join our team at HR Studio.The ideal candidate will have the ability to analyze and resolve verbal and written claims and authorization appeals through coordination with providers and members. Key responsibilities include preparing responses within required timeframes, tracking the status of all appeals, and...
-
Appeals Resolution Specialist
2 weeks ago
Sandton, South Africa HR Studio Ltd Full timeAt HR Studio Ltd, we are seeking a highly skilled Appeals Resolution Specialist to join our team. As an integral part of our organization, you will play a crucial role in analyzing and resolving verbal and written claims and authorization appeals.Job SummaryThis is a unique opportunity to leverage your expertise in grievance and appeals, claims, or related...
-
Claims Appeals Representative
4 weeks ago
Sandton, South Africa HR Studio Full timeWe are seeking an Appeals and Complaints Resolutions Specialist to join our team at HR Studio.This role requires a highly organized and detail-oriented individual with excellent communication skills to analyze and resolve verbal and written claims and authorization appeals.The ideal candidate will have 2+ years of grievance and appeals, claims or related...
-
Claims Appeals Call Centre Agent
1 month ago
Sandton, South Africa HR Studio (Pty) Ltd Full timeWe’re looking for… An Appeals Specialist that will analyze and resolve verbal and written claims and authorization appeals through coordination with providers and members. You will be preparing responses within required timeframes and track the status of all appeals with exemplary record-keeping. Who are you? - You have the ability to communicate...
-
Claims Appeals Call Centre Agent
3 months ago
Sandton, South Africa HR Studio Full timeWe're looking for… An Appeals Specialist that will analyze and resolve verbal and written claims and authorization appeals through coordination with providers and members. You will be preparing responses within required timeframes and track the status of all appeals with exemplary record-keeping. Who are you? You have the...
-
Appeals Resolution Specialist
2 weeks ago
Sandton, South Africa HR Studio Full timeAbout HR StudioWe're a leading provider of innovative solutions for the healthcare industry.
-
Social Media Specialist
6 months ago
Sandton, South Africa Regenesys Full timeRegenesys seeks to hire Social Media Specialists who will be responsible for planning and executing social media strategies, creating and publishing content to a variety of platforms, and interacting with their communities and audiences. The successful incumbent also needs to measure results by tracking metrics and insights on each platform. In addition,...
-
Sandton, South Africa Eduvos Full timeEduvos is a leading educational institution dedicated to providing quality learning experiences to students across the country. As a Content Creation Specialist for Humanities Education, you will play a critical role in shaping the academic content for our Humanities Department.Job Summary:We are seeking an experienced and skilled Content Creation Specialist...
-
Specialist Production Analyst
5 months ago
Sandton, South Africa Absa Bank Limited Full timeEmpowering Africa’s tomorrow, together one story at a time. - With over 100 years of rich history and strongly positioned as a local bank with regional and international expertise, a career with our family offers the opportunity to be part of this exciting growth journey, to reset our future and shape our destiny as a proudly African group.Job Summary We...
-
Junior UI Design Specialist
2 months ago
Sandton, South Africa Absa Bank Limited Full timeEmpowering Africa’s tomorrow, together one story at a time. - With over 100 years of rich history and strongly positioned as a local bank with regional and international expertise, a career with our family offers the opportunity to be part of this exciting growth journey, to reset our future and shape our destiny as a proudly African group. Job...
-
Business Intelligence Specialist
7 months ago
Sandton, South Africa Wilderness Full time**Primary Purpose**: **Key Responsibilities** - BI Development: Design, develop, and maintain interactive and visually appealing dashboards using QlikSense and/or QlikView. - Data Analysis: Utilise advanced analytical techniques to extract meaningful insights from complex datasets, driving informed decision-making across the organisation. - Dashboard...
-
Sandton, South Africa BDO South Africa Full timeBDO South Africa is seeking a skilled International Tax and Remuneration Specialist to join their team in Johannesburg.Job SummaryThis role involves managing a portfolio of expatriate tax compliance and consulting projects, working closely with the head of the division and interacting with clients directly.The successful candidate will also be responsible...
-
Digital Marketing Specialist
4 weeks ago
Sandton, South Africa Catch Recruit Full timeRole SummaryIn a fast-paced environment, Catch Recruit is seeking a talented individual to join their Digital Marketing Team. The ideal candidate will have a focus on front-end development and a proven track record of delivering visually appealing and responsive websites, landing pages, and online marketing campaigns.Key Responsibilities• Develop and...
-
Senior Mobile Application Engineer
2 weeks ago
Sandton, South Africa BAEC Specialists Full timeWe are seeking a highly skilled Senior Mobile Application Engineer to join our team at BAEC Specialists. As a key member of our mobile development team, you will be responsible for designing and developing innovative mobile applications that meet the needs of our clients.Key Responsibilities:Design and develop mobile applications for both iOS and Android...
-
Frontend Developer Specialist
3 weeks ago
Sandton, South Africa Dimension Data Full timeAbout the RoleWe are seeking a skilled Senior Frontend Developer to join our development team for one of our products. As a Senior Frontend Developer, you will be responsible for building new features and improving existing ones by creating beautiful, responsive web applications. Your experience in developing with JavaScript, CSS, HTML (or equivalent...
-
Digital, Marketing and Social Media Specialist
6 months ago
Sandton, South Africa C & G (Hospitality) Recruitment Full timeA luxury Hotel Group in Sandton is requiring a Marketing, Online and Social Media Specialist. You will be responsible for representing the client through their online presence by implementing and managing the Company’s Social Media strategy in order to increase the online presence and improve our marketing and sales efforts. - Implement and manage the...
-
Brand Manager
2 months ago
Sandton, South Africa Blueion Support Services Full timeTo help us continue on our already impressive growth trajectory, we’re on the lookout for a brand marketing manager to support the Chief Marketing Officer in delivering upon brand strategies across target markets. **RESPONSIBILITIES** - Ownership of Premier Bet brand strategy across 18 African markets, driving targeting, positioning and marketing...