NJM Insurance Group
Auto Insurance • Workers' Compensation Insurance • Homeowners Insurance • Commercial Auto Insurance • Renters Insurance
1001 - 5000 employees
Founded 1913
UM Appeals Analyst
2 days ago
NJM Insurance Group
Auto Insurance • Workers' Compensation Insurance • Homeowners Insurance • Commercial Auto Insurance • Renters Insurance
1001 - 5000 employees
Founded 1913
Description
• Supports Health Services and Utilization Management functions. • Acts as liaison between Members, Physicians, and Delegates. • Prepares/presents appeals cases for Member Appeals Committee. • Conducts root cause analysis to avoid future appeal occurrences. • Mentors junior staff in appeal processes.
Requirements
• High School Diploma/GED required. • Requires minimum of 5 years healthcare industry or operations experience. • Requires minimum 3 years direct customer service experience, preferably in a medical support related position. • Prefer experience with prior appeals handling and correspondence. • Knowledge of medical terminology, UCSW, Medical Policy guidelines, Care Radius, contracts, enrollment, billing, & claims coding/processing, Managed Care principles. • Requires strong oral and written communication skills. • Able to make sound decisions under supervision.
Benefits
• Comprehensive health benefits (Medical/Dental/Vision) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • Paid Volunteer Time Off • Tuition Reimbursement
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