WorkPartners Appeal Specialist (Part-Time)

UPMC Health Plan and WorkPartners is hiring a part-time Appeals Specialist. This position will work 20 hours per week and can set their schedule, provided they work during EST business hours and maintain consistent daily availability.

This position is responsible for the handling of short-term disability first level appeals along with quality reviews of claims being handled by the short-term disability unit as assigned by the department Manager. The Appeal Specialist may serve as an information resource for the ERISA committee on 2nd level appeal issues.

Responsibilities:
 

• Provides thorough and timely documentation of all activities undertaken in the course of investigating Short-Term Disability appeals.
• Serve as a role model of service excellence. Maintain a positive attitude, meet customer commitments and respond promptly to customer needs.
• Testifies as necessary in legal proceedings.
• All appeals should, where possible be processed in conformity with (where applicable) the Employee Retirement Income Security Act of 1974 as amended (ERISA) and the accompanying regulations, state law and/or regulatory requirements and in conformity with company/client guidelines.
• Investigate, handle and resolve Short-Term Disability appeals received from the Complaints and Grievances department within specified timeframes.
• Provides audit reviews of each case that files an appeal to the department Manager for review and ongoing training.
• Provides appropriate feedback to Management for training purposes.
• Monitor the inventory of Short-Term Disability appeals and provide monthly reports to the department Manager.
• Maintains a caseload of appeal files and reviews, evaluates and investigates (where necessary) denied claims which have been properly appealed and determines whether the decision to deny the claim was appropriate.
• Ensures that communications on appeals are thorough and accurate and sent in writing to the claimant or their authorized representative in a timely manner.
• Provides summary on all Short-Term Disability appeal decisions to the department Manager.