15 days old

Claims Appeal Specialist

Kelly Services
Richardson, TX 75081
Kelly Services is looking for candidates with Claims Appeals experience for a well-known healthcare company in Richardson, TX!


Under supervision, this position is responsible for processing, organizing, and coordinating all materials and information relating to processing appeals for all lines of business following federal, state, and accreditation requirements; and for accurately responding by telephone, in person, or through correspondence to all inquiries involving requests for appeals from members, the Department of Labor, or ERISA; sending acknowledgement letter to member and draft provider letters for directors signature; entry of appeals into appropriate database; and processing of internal quality of care referrals.


1. Complete, organize and oversee the appeal process of the unit to ensure all telephone and written appeals are processed accurately and promptly.

2. Coordinate all appeal functions which involves preparing summary reports; categorizing and routing medical appeals to the appropriate departments for action, and acting as the liaison with other units regarding appeal issues.

3. Accurately respond by telephone, in person, or through correspondence to all inquiries involving requests for appeals

4. Determine need for obtaining additional information and notifying members and/or providers as related to the processing of appeals.

5. Respond to appeal requests within designated time requirements.

6. Acknowledge member complaints within the regulatory timeframe.

7. Compose letter to provider for management approval, track timeliness of response, and send follow-up letters as appropriate.

8. Coordinate internal quality of care referral.

9. Promote goodwill of our customer population through capable, efficient, caring, and composed performance.

10. Coordinate and maintain system of tracking member complaints and appeals which includes identification and resolution of member concerns or outcome of appeal or internal quality of care referral.

11. Provider support to supervisor, and appeals RN, and grievance coordinator as necessary.

12. Identify trends and communicate this information to the supervisor.

13. Communicate and interact effectively and professionally with co-workers, management, customers, etc.

14. Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.

15. Maintain complete confidentiality of company business.

16. Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.


* 2 years experience researching and responding to telephone and / or correspondence inquiries regarding health insurance claims/services OR 1 year health insurance plus 2 years of customer service experience.

* Effective analytical, problem solving and research skills.

* Effective organizational skills to accommodate large volume of reference materials combined with time management skills to achieve accessibility to callers.

* Effective verbal and written communication skills to include the ability to clearly express oneself in a well-modulated tone with correct grammar and attention to enunciation.


* BlueChip claims payment experience.

* Medical terminology.

* Knowledge of appeals processing.

* Ability to think clearly and maintain a professional, poised attitude under pressure.

* Detail oriented.

* Bi-lingual Spanish speaking.

**_Please note: This position is NOT being recruited for by your local Kelly office. To apply, please contact nikki.adams@kellyservices.com_**

**Why Kelly** **** **?**

As a worker today, its up to you to take charge of your career and look for opportunities to learn, grow, and achieve your potential. Helping you find whats next is what were all about. We know whats going on in the evolving world of workjust ask the 440,000 people we employ each year. Connecting with us means getting the support, guidance, and opportunities needed to take your career where you may have never imagined.

**About Kelly** ****

At Kelly, were always thinking about whats next and advising job seekers on new ways of working to reach their full potential. In fact, were a leading advocate for temporary/non-traditional workstyles, because we believe they allow flexibility and tremendous growth opportunities that enable a better way to work and live. Connecting great people with great companies is what we do best, and our employment opportunities span a wide variety of workstyles, skill levels, and industries around the world.

Kelly is an equal opportunity employer committed to employing a diverse workforce and providing accommodations for people with disabilities in all parts of the hiring process as required under its Employment Accommodation Policy. Kelly will work with applicants to meet accommodation needs that are made known to Kelly in advance.
Posted: 2021-02-12 Expires: 2021-03-15

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Claims Appeal Specialist

Kelly Services
Richardson, TX 75081

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