IQA Appeals Specialist jobs in United States
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Medata · 2 months ago

IQA Appeals Specialist

positionUnited States
timeFull-time
remoteRemote
senioritySenior Level
money$27/hr - $31/hr
date5+ years exp

Medata is a company specializing in IQ analysis, and they are seeking an IQA Appeals Specialist to manage complex appeals. The role requires advanced analytical skills and legal and medical knowledge to navigate high-stakes claim scenarios.

ComputerSoftware

Responsibilities

Review and evaluate complex appeals cases involving disputed workers’ compensation claims
Draft detailed and persuasive appeal responses and documentation
Collaborate with legal counsel, gather necessary documentation, and support case resolution
Track and manage appeal timelines to ensure all deadlines are met
Identify trends and recurring issues in appeals and recommend process improvements
Maintain accurate and thorough documentation in the claims management system

Qualification

Workers' compensation experienceLegal knowledgeMedical terminologyClaims management systemsAnalytical skillsMicrosoft Office SuiteMulti-state WC programsTPA experienceInsurance carrier experienceMedical cost containment experienceProcess improvementWritten communicationVerbal communicationAttention to detailProblem-solving skills

Required

5+ years of experience in workers' compensation claims or appeals
Strong understanding of workers' compensation regulations, medical terminology, and legal processes
Excellent written and verbal communication skills, with the ability to draft clear and persuasive documentation
High attention to detail and ability to manage multiple complex cases independently
Proficient in claims management systems and Microsoft Office Suite
Strong analytical and problem-solving skills

Preferred

Certification in Workers' Compensation (e.g., CWCP, WCCA/WCCP)
Experience working with multi-state WC programs or in a TPA, insurance carrier, or medical cost containment company

Company

Medata

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Medata is a computer software company specializing in medical bill review software and medical bill review software.
dateFounded in 1975
location
Irvine, California, USA
people-size201-500 employees
web-link
http://medata.com

Funding

Current Stage
Growth Stage
Total Funding
unknown
2024-01-09Acquired

Leadership Team

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Jonathan Nutt
Chief Technology Officer
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Dana Joanou
Chief Financial Officer
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