Senior Appeal Examiner - Remote

Overview

The Senior Appeal Examiner (Meritain Health) is responsible for managing complaint and appeal scenarios for all products, ensuring timely, customer-focused responses and identifying trends to recommend solutions.

In Short

• Manage and resolve complaints and appeals.
• Review and analyze complex appeals.
• Facilitate interpretation of policy and coverage guidelines.
• Draft resolution letters.
• Ensure timely handling of assigned cases.
• Assist in coaching and mentoring other analysts.
• Coordinate external reviews as needed.
• 1+ years of experience in healthcare appeals and claims.
• Working knowledge of Microsoft Office products.
• Strong familiarity with medical terminology and ERISA requirements preferred.

Requirements

• 1+ years of experience with healthcare appeals, claims, and compliance.
• Experience with plan documents and claims research.
• High school diploma or GED required.
• 3+ years of experience with claims and/or health insurance preferred.

Benefits

• Affordable medical plan options.
• 401(k) plan with matching contributions.
• No-cost wellness programs.
• Paid time off and flexible work schedules.
• Tuition assistance and dependent care resources.