Appeals Specialist

**Key Responsibilities**

+ **Responsible for case development and resolution of non-clinical cases, such as: certain types of claim denials, member complaints, and member and provider appeals. The end-to-end process requires the Specialist to independently:**
+ **Research issues**
+ **Reference and understand HFs internal health plans policies and procedures to frame decisions**
+ **Interpret regulations**
+ **Resolve cases and make critical decisions**
+ **Edit and finalize resolution letters**
+ **Manage all duties within regulatory timeframes**
+ **Communicate effectively to hand-off or pick-up work from colleagues**
+ **Work within a framework that measures productivity and quality for each Specialist against expectations**
+ **Work independently exercising judgment starting the case development with the respective internal and external entities in the timeframe prescribed in the Job Aid and//or regulatory timeframes.**
+ **Prepare...