Healthcare Specialist

About the role

Xploy Solutions is seeking a Healthcare Specialist to manage individual client cases through the appeals process. The role focuses on high-quality submissions, timely follow-ups, data accuracy, and collaborative problem-solving within the Appeals Team.

Responsibilities

• Manage assigned client appeal cases, filing appeals on time and following up within designated turnaround times.
• Ensure appeal submissions meet the company’s quality, compliance, and clinical standards.
• Use Guided Care software to manage cases and keep data accurate, complete, and up to date.
• Understand the appeals workflow and quality expectations, and participate in process improvements when needed.
• Respond promptly to colleagues and leadership and communicate respectfully.
• Participate in training, respond constructively to feedback, and attend scheduled team and supervisor meetings.
• Uphold the company’s GUIDE principles, maintain excellent attendance, and perform other assigned duties.

Requirements

• At least 3 years of experience in a healthcare environment.
• Microsoft Office proficiency and the aptitude to learn new programs quickly.
• Independence, self-motivation, attention to detail, and strong research and organizational skills.
• Strong time management, critical thinking, and ability to meet deadlines.
• Collaborative skills and the ability to establish and maintain positive relationships with colleagues and clients.
• Ability to clearly exchange information and ideas.
• Discretion, sensitivity, and ability to maintain strict confidentiality.

Datos clave

• Requires at least 3 years of experience in a healthcare environment.
• Requires Microsoft Office proficiency and the aptitude to learn new programs quickly.
• Responsibilities include managing client appeal cases and meeting designated turnaround times.