Care Specialist

The Appeals Specialist is responsible for managing individual client cases through the appeals process, ensuring high-quality submissions and timely follow-ups to secure continuous positive results for clients. This role focuses on execution, data accuracy, and collaborative problem-solving within the Team.
Responsibilities:● Manages and processes assigned client appeal cases diligently, ensuring all appeals are filed timely and followed up on within designated turn-around times (TATs).● Ensures all individual appeal submissions meet defined quality, compliance, and clinical standards set forth.● Maintains a full understanding of Guided Care software for managing client cases, ensuring all data is entered accurately and completely, and kept up to date.● Demonstrates a strong understanding of the appeals workflow and quality expectations, actively participating in process improvement steps when needed.● Responds to colleagues and leadership promptly and maintains respectful communication in all interactions.● Participates in initial/ongoing training, responds constructively to real-time feedback, and attends team and supervisor meetings as scheduled.● Upholds and practices core company principles (GUIDE) in all work-related interactions.● Demonstrates excellent attendance and performs other duties as assigned.
Requirements● 3+ years of experience in a healthcare environment.● Microsoft Office proficiency, with the aptitude to learn new programs quickly.● Independent, self-motivated, and detail-oriented professional with strong research and organizational skills.● Strong time management with a proven ability to think critically and meet deadlines.● Solid collaborative skills with the ability to establish and maintain positive relationships with colleagues and clients.● Ability to clearly exchange information and ideas so others will understand.● Demonstrates discretion, sensitivity, and the ability to maintain strict confidentiality.● Must have a quality camera for internal and client video meetings (Zoom/Teams).● Must remain fully focused on the meeting at hand and refrain from multitasking during calls.● Punctuality is required; best practice is joining scheduled meetings 3 minutes early to ensure strong professional representation.