Appeals Quality Specialist

Job Summary

A company is looking for an Appeals Quality and Training Specialist who supports the Appeals Department through quality monitoring and training.

Key Responsibilities

• Conducts quality monitoring and training for the Appeals Department
• Develops and revises internal policies and procedures in collaboration with leadership
• Prepares for and participates in auditing activities, providing feedback on performance gaps

Required Qualifications

• Bachelor's degree or equivalent combination of relevant education and experience
• 3+ years of experience in the health insurance field
• Proven experience in a mentoring role capacity
• Knowledge of enrollment/disenrollment guidelines and claims processing
• Experience with TRICARE and US Family Health Plan manuals related to appeals