Appeals Specialist II

Appeals Specialist II

BC Forward is looking for Appeals Specialist II - 100% Remote

Position Title: Appeals Specialist II

Location: Remote

Duration: 06 Months of contract with possibility to extend or convert

Pay Rate: $23.00/hr. on W2

Note: Need to complete Typing test - Ability to type at least 45 WPM with high accuracy

Work Schedule:

• Training: 8:00 AM - 4:00 PM CST (8 weeks, no time off, camera required)
• Standard Schedule:
• Option 1: 7:00 AM - 3:30 PM CST (30-min lunch)
• Option 2: 7:00 AM - 4:00 PM CST (1-hr lunch)
• Remote, fully virtual with camera-on meetings

Position Purpose:

Supports the documentation and processing of appeals, disputes, and reconsiderations to ensure compliance with state and NCQA requirements. Ensures timely review and processing of assigned cases.

Key Responsibilities:

• Perform data entry to track, log, and process appeals, disputes, and reconsiderations per regulatory and accreditation guidelines.
• Prepare correspondence and maintain documentation files.
• Review and investigate appeals, disputes, and reconsideration requests to determine appropriate follow-up.
• Conduct research to evaluate, process, and respond to cases.
• Prepare case files with supporting documentation and determinations.
• Gather data to track and report trends and final outcomes; conduct outreach as needed for updates on statuses and determinations.
• Comply with all company policies and standards.
• Perform other duties as assigned.

Qualifications:

Education & Experience:

• High School Diploma or GED required.
• 1-2 years of related experience required; experience with claims, billing, or authorizations preferred.

Skills & Knowledge:

• Data entry / typing: 40 WPM
• Knowledge of claims/coding
• Knowledge of authorizations
• Familiarity with TruCare, Amisys, and Cenpas systems preferred
• Strong computer skills: Excel, Word, Teams, Outlook, OneDrive, OneNote

Performance Expectations:

• After training, complete 50 case reviews daily with ≥95% monthly quality accuracy.
• Adhere to all timelines and performance metrics as assigned.

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 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.

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Interested candidates please send resume in Word format Please reference job code 249374 when responding to this ad.

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