Southwest Services Administrators

  • Appeals Coordinator

    Job Locations US-AZ-Phoenix
    Posted Date 3 months ago(4/25/2018 11:37 AM)
    Job ID
    2018-1124
    # of Openings
    1
    Category
    Claims
  • Overview

    Southwest Service Administrators is a Third Party Administrator (TPA) providing unique and specialized administrative services to labor-management Trust Funds (primarily) in the southwest United States with offices in Phoenix, AZ (our corporate service center), Albuquerque, NM and Salt Lake City, UT since 1995.

     

    We offer competitive wages and an excellent benefit package including FULL FAMILY coverage for medical, dental, vision & Rx. Other benefits include (employee) short & long term disability, Life/AD&D Insurance, 401k, Pension, generous Paid Personal & Vacation Leave policy and career advancement and travel opportunities.

     

    Southwest Service Administrators is currently hiring an experienced Appeals Coordinator.  The focus of this position is providing expertise in reviewing, researching including investigating, negotiating, and resolving all types of appeals and grievances, both verbal & written, from members and providers within stringent timeframes

    Responsibilities

     

    • Prepare acknowledgment and response letters to members and providers
    • Maintain case records on all complaints, grievances, and appeals
    • Identify, research and resolve claim disputes received from a variety of sources
    • Understanding of claims processing and an ability to research claims issues
    • Ability to multitask on multiple appeals simultaneously, prioritizing work and completing within stringent timeframes
    • Prepare statistical analysis for required reporting
    • Analyzes and tracks trends
    • Other duties as assigned

    Qualifications

     

    • Prior grievance and appeals experience preferred
    • Minimum five years claims experience with coding certificate
    • Certified professional coder with experience handling appeal in a providers office
    • Proficiency in interpretation of plan documents
    • Excellent oral and written communication skills
    • Intermediate skills with Excel, Word & Outlook
    • Demonstrates excellent attendance
    • Must have strong 10-key, keyboarding, and mathematical skills
    • Strong analytical & research skills
    • Excellent organizational skills & attention to detail
    • Ability to sit for long periods of time operating a computer keyboard.
    • Bi-lingual in English and Spanish a plus.

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