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Appeals Intake Specialist

United States - Remote

Reliant Health Partners is an innovative medical claims repricing service provider, helping employers achieve maximum health plan savings with minimum noise. We tailor our services to each client’s needs, providing everything from individual specialty claims repricing, to full plan replacement as a high-performance, open-access network alternative. 

As an Appeals Intake Specialist, you will play a critical role in resolving post-payment disputes related to Workers’ Compensation bills. This includes conducting provider outreach, negotiating disputed charges, and ensuring compliance with state-specific regulations. Your work will directly support our cost containment efforts and ensure appropriate bill reimbursement for our clients.

Primary Responsibilities

  • Responsible for screening/returning all voicemails and answering questions
  • Offer guidance to providers including sharing details on documents needed to process their appeal/reconsideration request
  • If the situation appears to have issues escalating to the senior appeal specialist for direction
  • Responsible for monitoring/managing the shared appeals inbox
  • Locating the bill in question and assigning to the appropriate team member for handling
  • Creation of appeal case in Salesforce or Claimsave
  • Update the attorney referred cases spreadsheet based on received emails
  • Bimonthly report updates shared with clients on cases referred to attorneys
  • Responsible for updating claim platform with new status received from attorneys
  • Work with senior appeal specialist on updates needed to the process SOP’s
  • Insures accurate and thorough documentation in claims platform for every email and voicemail.
  • Demonstrates knowledge about workers’ comp and Reliant processes
  • Adheres to our department TAT, either individual claim based or organization wide
  • Understands the support function of the job and assumes responsibility for assignments.
  • Establishes and prioritizes job tasks, desired solutions to problems and develops a realistic plan for their accomplishment.

Qualifications

  • 1 -2 years of relevant experience in Workers’ Compensation bills or appeals.
  • Strong understanding of Workers’ Compensation reimbursement methodologies, state regulations, and provider billing practices.
  • Experienced communicator with providers and clients
  • Ability to collaborate with a variety of individuals both internally and externally.
  • Familiarity with claims processing systems and provider communications.
  • Excellent communication and organizational skills.
  • Requires organizational skills, communication proficiency, discretion, ethical conduct, decision making, technical skills

Individual compensation will be commensurate with the candidate's experience and qualifications. Certain roles may be eligible for additional compensation, including bonuses, and merit increases. Additionally, certain roles have the opportunity to receive sales commissions that are based on the terms of the sales commission plan applicable to the role.

Pay Transparency

$50,000 - $55,000 USD

Benefits:
  • Comprehensive medical, dental, vision, and life insurance coverage
  • 401(k) retirement plan with employer match
  • Health Savings Account (HSA) & Flexible Spending Accounts (FSAs)
  • Paid time off (PTO) and disability leave
  • Employee Assistance Program (EAP)

Equal Employment Opportunity: At Reliant, we know we are better together. We value, respect, and protect the uniqueness each of us brings. Innovation flourishes by including all voices and makes our business—and our society—stronger. Reliant Health Partners is an equal opportunity employer and we are committed to providing equal opportunity in all of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, social, and recreational activities to all persons regardless of race, religious creed, color, national origin, ancestry, physical disability, mental disability, genetic information, pregnancy, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, and military and veteran status, or any other protected status protected by local, state or federal law.

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