Appeals Specialist II

BCforward is currently seeking a highly motivated Appeals Specialist II for an opportunity in Remote!

Position Title: Appeals Specialist II

Location: Remote

Expected Duration : 12+ months with possible extension

Pay Rate: $24/hr.

Monday-Friday, 8 AM -5 PM

**Position Purpose:**

The Appeals, Disputes, and Reconsiderations Specialist supports the documentation and processing of appeals, disputes, and reconsiderations, ensuring compliance with state regulations and National Committee for Quality Assurance (NCQA) requirements. The role works closely with the team to ensure all appeals, disputes, and reconsiderations are reviewed and processed in a timely manner.

**Education/Experience:**

- High School diploma or GED required.

- 1 - 2 years of related experience preferred.

**Key Responsibilities:**

- Perform data entry to track, log, and process appeals, disputes, and reconsiderations in alignment with established regulatory and accreditation guidelines.

- Prepare correspondence for appeals, disputes, and reconsiderations while maintaining accurate documentation files.

- Review and investigate requests for appeals, disputes, and reconsiderations to determine the appropriate follow-up actions.

- Conduct research to evaluate, process, and respond to appeals, disputes, and reconsiderations to ensure timely decisions.

- Prepare case files with supporting documentation and determinations required for reviewing, processing, and reporting appeals, disputes, and reconsiderations.

- Gather data related to appeals, disputes, and reconsiderations to track trends and outcomes, providing updates on statuses, determinations, and explanations.

- Conduct outreach to relevant parties for status updates and clarifications regarding appeals, disputes, and reconsiderations.

- Perform other duties as assigned.

- Comply with all relevant policies, standards, and procedures.

**Skills and Qualifications:**

- Knowledge of appeals, disputes, and reconsiderations processes preferred.

- Strong organizational and time-management skills with the ability to handle multiple tasks simultaneously.

- Detail-oriented with strong data entry and documentation skills.

- Ability to work both independently and as part of a team.

- Good communication skills for preparing correspondence and conducting outreach.

Benefits:

BCforward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.

About BCforward:

Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally.

BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.

BCforward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.

To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.

This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.

Interested candidates please send resume in Word format Please reference job code 232079 when responding to this ad.