Appeals & Reserves Specialist

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
- 1 year contract

**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

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.

**To get a taste of the Global Excel life and for more information on our company, visit our Facebook page and website**:
**Job Types**: Full-time, Contract