Claims Appeals Specialist III (Health Insurance)

HMA is the premier third-party health plan administrator across the PNW and beyond. We relentlessly deliver on our promise to provide medium to large-size employers with customized health plans. We offer various high-quality, affordable healthcare plan options supported with best-in-class customer service.
We are proud to say that for four years, HMA has been chosen as a 'Washington's Best Workplaces' by our Staff and PSBJ™. Our vision, 'Proving What's Possible in Healthcare™,' and our values, People First!, Be Extraordinary, Work Courageously, Own It, and Win Together, shape our culture, influence our decisions, and drive our results.
What we are looking for: We are always searching for unique people to diversify our team. We only hire people that care deeply about others, thrive in evolving environments, gain satisfaction from being part of a team, are motivated by tackling complex challenges, are courageous enough to share ideas, action-oriented, resilient, and results-driven.
What you can expect: You can expect an inclusive, flexible, and fun culture, comprehensive salary, pay transparency, benefits, and time off package with plenty of personal development and growth opportunities. If you are looking for meaningful work, a clear purpose, high standards, work/life balance, and the ability to contribute to something important, find out more about us at: https://www.accesshma.com/
How YOU will make a Difference:
This role will use critical thinking skills to each unique appeal or reconsideration request and craft, edit and finalize precise and accurate written communication in the form of letters and client facing communication. This position will conduct outreach regarding appeal status, determinations and explanations with a high of confidence and accuracy.
What YOU will do:

• Ensure that the TATs are being met on all of the appeals for member and providers
• Monitor and track the status of submitted appeals, ensuring timely follow-up and resolution.
• Review and analyze denied claims to determine the basis for denial and assess the potential for a successful appeal.
• Liaise with healthcare providers, patients, and insurance representatives to collect additional information or clarification needed for appeals.
• Take on difficult cases and figure out what needs to be done to come up with a determination for the appeal.
• Prepare and submit written appeals to a third party or vendor, including gathering necessary documentation and evidence to support the appeal.
• Interpret and apply current healthcare regulations, payer policies, and coding guidelines to ensure compliance in the appeals process.
• Analyze appeal outcomes to identify trends, patterns, or issues in denials, recommending process improvements to minimize future denials.

Knowledge, Experience, and Key Attributes needed for Success:

• High School Diploma Required
• 5-7+ years' previous experience with claims appeals and processing
• Excellent written and verbal communications and the ability to convey important details and information
• Proven ability to work independently and stay focused and motivated
• High attention to detail
• Experience working in a que to track deliverables during the appropriate TAT

Compensation The base salary range for this position in the greater Seattle area is $30/hr - $34/hr for a level II and varies dependent on geography, skills, experience, education, and other job or market-related factors. While we are looking for level II, we may consider level III for highly qualified candidates.
Disclaimer: The salary, other compensation, and benefits information are accurate as of this posting date. HMA reserves the right to modify this information at any time, subject to applicable law.
In addition, HMA provides a generous total rewards package for full-time employees that includes:

• Seventeen (IC) days paid time off (individual contributors)
• Eleven paid holidays
• Two paid personal and one paid volunteer day
• Company-subsidized medical, dental, vision, and prescription insurance
• Company-paid disability, life, and AD&D insurances
• Voluntary insurances
• HSA and FSA pre-tax programs
• 401(k)-retirement plan with company match
• Annual $500 wellness incentive and a $600 wellness reimbursement
• Remote work and continuing education reimbursements
• Discount program
• Parental leave
• Up to $1,000 annual charitable giving match

How we Support your Work, Life, and Wellness Goals
At HMA, we believe in recognizing and celebrating the achievements of our dedicated staff. We offer flexibility to work schedules that support people in all time zones across the US, ensuring a healthy work-life balance. Employees have the option to work remotely or enjoy the amenities of our renovated office located just outside Seattle with free parking, gym, and a multitude of refreshments. Our performance management program is designed to elevate career growth opportunities, fostering a collaborative work culture where every team member can thrive. We also prioritize having fun together by hosting in person events throughout the year including an annual all hands, summer picnic, trivia night, and a holiday party.
We hire people from across the US (excluding the state of Hawaii and the cities of Los Angeles and San Francisco.)
HMA requires a background screen prior to employment.
Protected Health Information (PHI) Access Healthcare Management Administrators (HMA); employees may encounter protected health information (PHI) in the regular course of their work. All PHI shall be used and disclosed on a need-to-know-basis and according to HMA's standard policies and procedures.
HMA is an Equal Opportunity Employer.
For more information about HMA, visit www.accesshma.com .