WorkPartners Appeal Specialist (Part-Time) at UPMC

Pittsburgh, Pennsylvania, United States -

Full Time

Start Date

Immediate

Expiry Date

10 Aug, 26

Salary

0.0

Posted On

12 May, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Short-Term Disability Appeals, Claims Management, ERISA Compliance, ADA, FMLA, FLSA, Medical Terminology, ICD-9, Case Management, Analytical Skills, Problem Solving, Written Communication, Customer Service, Time Management, Legal Testimony, Audit Review

Industry

Hospitals and Health Care

Description

UPMC Health Plan and WorkPartners is hiring a part-time Appeals Specialist. This position will work 20 hours per week and can set their schedule, provided they work during EST business hours and maintain consistent daily availability. This position is responsible for the handling of short-term disability first level appeals along with quality reviews of claims being handled by the short-term disability unit as assigned by the department Manager. The Appeal Specialist may serve as an information resource for the ERISA committee on 2nd level appeal issues. Responsibilities: Provides thorough and timely documentation of all activities undertaken in the course of investigating Short-Term Disability appeals. Serve as a role model of service excellence. Maintain a positive attitude, meet customer commitments and respond promptly to customer needs. Testifies as necessary in legal proceedings. All appeals should, where possible be processed in conformity with (where applicable) the Employee Retirement Income Security Act of 1974 as amended (ERISA) and the accompanying regulations, state law and/or regulatory requirements and in conformity with company/client guidelines. Investigate, handle and resolve Short-Term Disability appeals received from the Complaints and Grievances department within specified timeframes. Provides audit reviews of each case that files an appeal to the department Manager for review and ongoing training. Provides appropriate feedback to Management for training purposes. Monitor the inventory of Short-Term Disability appeals and provide monthly reports to the department Manager. Maintains a caseload of appeal files and reviews, evaluates and investigates (where necessary) denied claims which have been properly appealed and determines whether the decision to deny the claim was appropriate. Ensures that communications on appeals are thorough and accurate and sent in writing to the claimant or their authorized representative in a timely manner. Provides summary on all Short-Term Disability appeal decisions to the department Manager. Bachelor's degree required 3 years demonstrated experience working in a short-term disability appeals environment A minimum of 5 years of disability claims management experience, preferably short term disability. Experience managing compliance issues with various state and federal laws that impact disability management such as ERISA, ADA, FMLA and FLSA Must be self-motivated and have the ability to work independently and handle multiple priorities and deadlines simultaneously with minimal guidance. Excellent communication skills, both written and verbal, with the ability to write complex letters. Strong commitment to customer service and responsiveness to clients with the ability to handle emotionally charged situations. Demonstrated time management skills, ability to prioritize and identify critical tasks that deliver the highest impact. Ability to exercise sound judgment and act in a decisive manner to minimize risk to the organization/clients. Attention to detail, strong organizational, communication, planning analytical and problem solving skills are critical to the success of this position. Forge strong interpersonal relationships within the department and with other departments outside the organization. High degree of professionalism, enthusiasm and initiative on a daily basis. Must be flexible and effective at exchanging ideas and managing the creative ideas of others to improve results. Strong knowledge of ICD-9 and medical terminology.Computer skills/literacy a must Licensure, Certifications, and Clearances: UPMC is an Equal Opportunity Employer/Disability/Veteran

Responsibilities

Responsible for handling first-level short-term disability appeals and performing quality reviews of claims. The role involves investigating denied claims, ensuring regulatory compliance, and providing detailed reports to management.