Appeals Specialist
1 week ago
We are seeking a skilled Appeals Specialist to join our team at HR Studio. As an integral part of our claims resolution process, you will play a critical role in ensuring timely and accurate resolutions to member and provider appeals.
Key Responsibilities- Analyze appeal issues and relevant claims using established guidelines and tools.
- Collect and analyze verbal and written complaints and appeals from members and providers, identifying key factors that impact resolution.
- Maintain detailed records of all complaints, resolutions, and documentation for tracking and auditing purposes.
- Draft response letters for member and provider appeals, ensuring clear and concise communication.
- Serve as a subject matter expert on appeals, providing guidance and support to internal teams and external stakeholders.
- Act as a liaison between members, providers, regulatory agencies, and internal teams, coordinating with key individuals regarding appeal decisions.
- Matric or equivalent; associate's degree preferred.
- Minimum 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.
- Able to maintain confidentiality and exercise discretion in handling sensitive information.
- A competitive salary range of $65,000 - $85,000 per annum.
- Ongoing training and development opportunities to enhance your skills and expertise.
- A dynamic and supportive work environment.
- The opportunity to work with a talented team of professionals who share your passion for delivering exceptional service.
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Appeals Resolution Specialist
1 month 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...
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Appeals Resolution Specialist
4 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...
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Claims Appeals Resolution Specialist
3 days ago
Sandton, South Africa HR Studio Ltd Full timeWe are seeking a highly skilled Claims Appeals Resolution Specialist to join our team at HR Studio Ltd. This is a fantastic opportunity for an experienced professional to take on a challenging role in the healthcare industry.In this position, you will be responsible for analyzing and resolving verbal and written claims and authorization appeals through...
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Senior Appeals Specialist
2 days ago
Sandton, South Africa HR Studio Ltd Full timeJob Title: Senior Appeals Specialist - Claims Resolution ExpertAbout the Role:We are seeking a highly skilled and experienced Senior Appeals Specialist to join our team at HR Studio Ltd. As a key member of our appeals department, you will play a vital role in analyzing and resolving complex claims and authorization appeals.Key Responsibilities:• Conduct...
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Appeals Specialist
4 days ago
Sandton, South Africa HR Studio Ltd Full timeJob SummaryWe are seeking an experienced Appeals Specialist to join our team at HR Studio Ltd. The successful candidate will be responsible for analyzing and resolving verbal and written claims and authorization appeals in a fast-paced environment.Key Responsibilities:Analyze appeal issues and relevant claims using guidelines and tools, ensuring accurate...
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Appeals Specialist
2 weeks ago
Sandton, South Africa HR Studio Ltd Full timeJob OverviewWe are seeking an Appeals Specialist to join our team at HR Studio Ltd. This role will involve analyzing and resolving verbal and written claims and authorization appeals through coordination with providers and members.The successful candidate will have a strong understanding of CMS standards and requirements related to complaint resolution, as...
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Appeals Resolution Specialist
6 days ago
Sandton, South Africa HR Studio Ltd Full timeWe are seeking a skilled Appeals Resolution Specialist to join our team at HR Studio Ltd. As an integral part of our operations, you will be responsible for analyzing and resolving verbal and written claims and authorization appeals.The ideal candidate will have excellent analytical and communication skills, with the ability to work effectively in a...
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Sandton, South Africa HR Studio Ltd Full time**Company Overview**At HR Studio Ltd, we are dedicated to providing exceptional service to our clients. Our team of professionals is committed to delivering high-quality solutions that meet the needs of our customers.**Job Description**We are seeking a skilled Appeals Resolution Specialist to join our team. The successful candidate will be responsible for...
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Claims Appeals Call Centre Agent
4 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...
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Appeals Resolution Specialist
4 weeks ago
Sandton, South Africa HR Studio Full timeAbout HR StudioWe're a leading provider of innovative solutions for the healthcare industry.
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