Description PURPOSE: The Appeals Specialist II will be responsible for the initial intake analysis of appeals/grievances correspondence and determination of next steps with minimal supervision for Government Program lines of business. Responsible for collecting organizing and tracking information to facilitate and expedite processing of appeals and grievances received from a variety of sources. Responsible for more complicated high level research of cases and other special projects as well as serving as a subject matter expert. ESSENTIAL FUNCTIONS: 50 Independently researches contractual benefits limitations exclusions and claims to assist medical professional staff in performing the review of appeals grievances and reconsiderations. Prioritize research analyze and perform accurate data entry for more complex appeals and grievances including high profile and escalated cases timely or expeditiously. Performs other duties such as file coordination activities including but not limited to filing of all active files purging of files for transport to off-site storage. 25 Utilizes professional written and verbal communications to assist in responses of all appeals and reconsiderations based on State and Federal requirements for all lines of business. Coordinates and completes vendor auditing duties as needed. Reviews researches problematic correspondence and works on special projects with Appeals Nurse or Management. 25 Interacts regularly with and responds to internal and external stakeholders without breaching confidentiality of medical information. Actively participates in monthly meetings and discussions regarding quality appeal research data entry and to problem solve any issues regarding the appeal intake/entry process. SUPERVISORY RESPONSIBILITY: Individual Contributor - Provides resolution to problems that are readily identifiable with limited scope and are resolved in accordance with standard practices procedures applications or routines. Problem/Task resolution timeframe: The majority of tasks typically take one to two days to resolve. Under general supervision proceeds alone or regular duties referring questionable cases to supervisor. Failure to accomplish results can normally be overcome without significant effect on the organization Contacts are primarily within the department or function with occasional cross-functional ?interfaces. Some limited external customer contact on routine matters. Qualifications To perform this job successfully an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education Level: High School Diploma or GED Education Details: Experience: 5 years experience in settings such as managed care health care or insurance payor environment 2 years experience in Appeals Management Preferred Qualifications College Degree Knowledge of CareFirst system Member/Provider Service Claims or Care Management experience a plus. Knowledge Skills and Abilities KSAs Research and Problem Solving Skills Advanced Ability to lead train coach and mentor less experienced team members. Advanced Ability to work both independently and as a member of a team with minimal supervision. Advanced Excellent organizational and analytical skills. Advanced Knowledge and understanding of medical terminology. Advanced The incumbent is required to immediately disclose any debarment exclusion or other event that makes them ineligible to perform work directly or indirectly on Federal health care programs. Must be able to effectively work in a fast-paced environment with frequently changing priorities deadlines and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer including customers who may be demanding or otherwise challenging. Additional Skills & Qualifications Looking for someone who can come in and hit the ground running Motivated MUST HAVE A&G experience, appeals & grievances - government (medicare, medicaid, dsnip) side is the preference, commercial experience is okay it does translate Experience Level Entry Level Pay and Benefits The pay range for this position is $30.00 - $30.00/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 Jul 31, 2025. h4>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. About TEKsystems and TEKsystems Global Services We’re a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We’re a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We’re strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We’re building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.