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Appeals Coordinator (Remote)
Posted on 7/26/2022
United States
Experience Level
Desired Skills
Customer Service
  • 2+ years healthcare experience (clinical practice in an outpatient or acute care setting) or working with health plans, coordinating care, authorizations and/or appeals
  • Knowledge of insurance industry and regulatory compliance to applicable state and federal laws
  • Assess incoming requests and inquiries for appeals, swiftly determining next steps and taking appropriate action
  • Timely and comprehensive resolution, abiding by internal Service level agreements and mandated turnaround times
  • Conduct a comprehensive review of case history and identify key elements, arguments and mitigating factors
  • Outreach to providers for medical records and to members as needed to gather details relevant to the appeals
  • Build tickets and gather case documents. Provide clear and accurate documentation in the ticketing system as to the progress and status of your work
  • Oversight and ownership of casework and timelines
  • Establish a strong rapport with the Clinical and CGA Teams; escalating and coordinating with clinical staff where needed
  • Escalation and coordination with the CGA staff when cases must be referred to the complaints, appeals and/or regulator teams
  • Work as a team to complete departmental tasks to meet deadlines and accomplish department goals. This may include evenings, weekends and holidays
Desired Qualifications
  • Bachelor's Degree
  • Strong proficiency navigating and working in multi-system environment (customer service, case management, claims)
Oscar Health

1,001-5,000 employees

Health insurance company
Company Overview
Oscar Health’s mission is to make high-quality health insurance accessible and affordable for everyone. The company is a software driven health insurance company that offers medical plans, medicare advantages, and small group products.
  • Health insurance - That’s a given. Employees and their families receive incredible health insurance.
  • Financial benefits - A penny saved....we’re talking about a 401K plan, health savings accounts, and more.
  • Well @ Oscar - We care about your wellness with fitness classes and access to mental health support.
  • Work-Life Balance - We offer multiple time-off options, wellness days, and 10+ weeks of parental leave.
  • Learning & Development - We offer everything from mentorship to management training.
Company Values
  • What we do is a big deal. We’re solving problems that change and save lives.
  • Powered by people. Members above all. Developing and growing others is what raises the bar.
  • No genius without grit. Be relentless. Be scrappy. Trying and failing beats not trying and changing nothing.
  • Seek the truth... but never assume you’ve found it. Be scientific.
  • Inspire & provoke. Develop and display leadership at all levels. Fight to be the best.
  • Be transparent. Give and ask for direct feedback. Be grateful for and excited by the help of others.
  • Make it right. Admit your mistakes. Then learn from them. Never build alone.