Appeals Specialist

Unified Group Services is a full-service third-party administrator (TPA) for self-insured group health plans. We're dedicated to providing excellent customer service and the flexibility our customers desire in administering employee benefit plans.

Unified Group Services has a reputation for excellent customer service in the marketplace, and this position is crucial to continuing that status.

Appeals may be submitted by providers and/or their representatives, members, attorneys, and sometimes a PPO (Preferred Provider Organization) may request a review.

JOB DESCRIPTION:

• Research internal/external appeal (benefit determination, Usual and customary reduction, discount dispute, eligibility).
• Work with internal review vendors on internal appeals and independent review organizations (IRO) on external reviews. This essential team review requires the employee to work inside the office.
• Work with our clients, reinsurance department, subrogation department, case management/pre-cert vendors, PPOs on occasion
• Draft letters in response to appeal (providers, provider representatives, members, occasionally an attorney)
• Adhere to plan timeframes regarding all aspects of appeals
• As with any job, there may be other tasks assigned as necessary.

JOB QUALIFICATIONS:

• High School Diploma or GED. Some college is helpful but not required
• Working knowledge of Microsoft Word, Excel, and Outlook is required
• Strong math skills.
• Attention to detail and the ability to meet deadlines are critical to success.
• Professional phone communication skills.
• Good organizational skills and excellent customer service.
• Good writing skills, using proper grammar, punctuation, and sentence structure.
• Problem-solving and decision-making skills are vital
• Self-motivated & self-starter with a willingness to learn.
• Excellent attendance.

PAY BASIS: Hourly

Hours are Monday through Friday, 8:00 a.m. to 5:00 p.m.

BENEFITS:

Unified Group offers an excellent benefits package including:

• Medical, dental, and vision insurance
• Matching 401K plan
• Life insurance
• Short and Long-term disability
• Student loan debt payments
• Vacation and PTO time
• Health Clinic
• Sponsored wellness plans.

OTHER REASONS TO WORK HERE:

• Family-oriented, positive work environment
• Weekends off
• Voluntary overtime during peak season
• Recently voted one of the Best Places to Work in Indiana!

This is an in-the-office position. We are located just off I-69, exit 226.

Unified Group Services is an Equal Opportunity Employer.