Appeals & Reserves Specialist

Employeur Global Excel
Horaire Temps plein
Type d'emploi Permanent
Domaine d'emploi Assurance, finance et services financiers
Télétravail possible

Une région à découvrir

Résumé du poste

Job Description

Are you a person that like to resolve problems? Are you interested in working in a multilingual, dynamic, and friendly environment that encourages personal and professional development? We would love to meet you!

As an Appeal & Reserve Specialist, you’ll be responsible for maintaining GEM discounts and provide client resolution on provider appeals and for providing accurate and timely reserves to all of GEM’s clients, while adhering to internal service level agreements and turnaround times. In addition, you will be responsible to provide the best educated estimate possible of the overall cost of a claim for our clients.

What does your typical day look like?

Review, determine course of action, and resolve network and GEM contracted appeals
Determine proactive strategies to prevent provider disputes
Identify and refer desired providers to join GEM network
Liaise with provider coding specialist regarding bill edit disputes
Perform additional reserve tasks within Manage Care’s scope such as review bill for revised charges, adjust reserve after denial, etc.
Research and set accurate reserves for high-cost claims
Participate in strategic rounds on a monthly basis
Provide internal support on appeal strategies

Estrie - Eastern Townships (English)


Eastern Townships (English)


Exigences et conditions

What skills and experience are we looking for?

College degree or equivalent
3-5 years of equivalent work experience
Knowledge of the U.S. Healthcare system
Excellent negotiation skills
Excellent interpersonal skills, judgment, and professionalism
Aptitude in Math
Ability to manage conflict efficiently

Avantages sociaux

We offer you

Competitive vacation package;
An extensive benefit package that includes health (100%), dental, life and travel insurance, as well as a retirement savings plan;
A flexible and supportive work environment offering several benefits such as on-call doctors, on-site Bistro, and much more;
A company wellness program that includes an on-site gym, opportunities to participate in fitness classes, discounts at local businesses as well as “lunch-and-learns” on various topics linked to health and wellness;
Many opportunities for advancement, development and financial assistance to employees who wish to continue their education.

Date d'affichage :

Date limite pour postuler : 30 avril 2023

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