Job Title: Remote Commercial Appeal Specialist Location: 100% Remote (Applicants must reside in New York State) Job Description: We are seeking a dedicated and detail-oriented Remote Commercial Appeal Specialist to join our team. This position is fully remote, but applicants must reside in New York State to qualify. Responsibilities: + Thoroughly investigate and resolve member appeals in a professional and timely manner, adhering to departmental and company processes and state guidelines. + Gather pertinent information from members, providers, facilities, and internal resources to respond to each appeal within designated time requirements. + Send timely resolution letters for cases. + Serve as the primary case contact for members, providers, and medical director reviewers regarding questions or requests. + Process and respond to member correspondence, identifying trends and presenting them to the Manager. + Educate members and providers on policies, procedures, and member benefits. + Perform claims and coding research to facilitate the processing of appeals, identifying trends and presenting them to the Manager. + Properly and fully document member appeals, including full documentation of contacts made or received, as well as any correspondence sent/received. + Send clearly written, detailed correspondence to members and providers for each appeal or correspondence in a timely manner. + Communicate clearly and effectively in written correspondence or orally, demonstrating an appropriate level of tact and diplomacy with internal/external contacts. Qualifications: + Must reside in the state of New York to qualify. + 1-2 years of medical claims/appeals experience. + Knowledge of managed care including health care benefits, regulations, medical and admin policies, and claims payment processing. Details: + 100% remote – equipment provided. Must reside in the state of NY to qualify. + Pay: $18.50/hr. + Pay cycle – weekly | medical, dental & vision benefits offered + Schedule: Monday – Friday | 8:30am – 5:00pm + Start Date: 4/21/2025 Pay and Benefits The pay range for this position is $18.50 - $18.50/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & vision• Critical Illness, Accident, and Hospital• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available• Life Insurance (Voluntary Life & AD&D for the employee and dependents)• Short and long-term disability• Health Spending Account (HSA)• Transportation benefits• Employee Assistance Program• Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to close on Apr 2, 2025. About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.