Job Closed

This listing is no longer active.

Össur logo
Össur

We improve people's mobility so they can live a Life Without Limitations

Authorization Appeal Specialist

Claims SpecialistClaims SpecialistOtherRemoteMid LevelTeam 1,001-5,000Since 1971H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

105 days ago

Salary

$29 - $31 / hour

Seniority

Mid Level

No structured requirement data.

Job Description

Authorization Appeal Specialist

Össur

About Us ForMotion is a global network of Orthotic and Prosthetic Patient Care clinics, focused on providing world-class, compassionate care for patients with mobility challenges.​ Our clinic is part of the ForMotion global network of Patient Care clinics owned by Embla Medical, which also owns Össur, a leading global provider of prosthetics and bracing and supports solutions; Fior & Gentz, an innovative developer of neuro orthotics; and College Park, creators of custom-built prosthetic solutions for people of all activity levels. We are dedicated to providing the best possible care to our patients to help them live Life Without Limitations. About the Role The Authorization Denial Appeal Specialist is responsible for managing and appealing denied prior authorizations for orthotic and prosthetic (O&P) devices across U.S ForMotion Clinics. This role partners closely with patients, clinicians, prescribing physicians, and payers to obtain required documentation, prepare comprehensive appeal submissions, and guide cases through payer review processes. The Specialist independently researches payer policies, develops case specific appeal strategies, submits complete appeal packages, and communicates appeal status through final determination. What You’ll Do   - Manage end to end appeal workflows for denied prior authorizations related to orthotic and prosthetic devices. - Collaborate with patients, clinicians, and prescribing physicians to obtain medical records, clinical notes, letters of medical necessity, and other supporting documentation required for appeals. - Obtain, track, and maintain signed Appointment of Representative (AOR) forms from patients to enable payer communication. - Research payer manuals, coverage guidelines, medical policies, and provider portals to identify denial rationale and appeal requirements. - Develop customized, case by case appeal strategies based on clinical justification, payer policy, and documentation standards. - Draft clear, comprehensive, and payer specific appeal letters supporting medical necessity and policy alignment. - Compile and submit complete appeal packages through payer portals, fax, mail, or other required submission channels. - Monitor appeal status through payer systems and follow up as needed to ensure timely review and resolution. - Coordinate and participate in Peer to Peer (P2P) reviews when required, including preparation of supporting materials and scheduling with clinicians or prescribing physicians. - Proactively communicate appeal status, updates, approvals, and denials to both the patient and the clinic throughout the review process. - Track appeal deadlines, determinations, and outcomes to ensure compliance with payer timelines. - Maintain accurate, compliant documentation in EMR systems and internal tracking tools. - Provide non-managerial guidance and subject matter support to peers regarding authorization and appeal processes. - Ensure strict adherence to HIPAA and other legal and ethical standards in the handling of protected health information. Who You Are - Ethical Conduct - Computer Proficiency - Demonstrates excellent people skills with the ability to interface with patients, physicians, and coworkers in a tactful, informed and service-oriented manner. - Detailed oriented. - Experience coordinating and participating in Peer to Peer (P2P) reviews. - Familiarity with Medicare, Medicaid, and commercial payer policies as they relate to O&P services. - Ability to interpret complex payer policy language and apply it to clinical scenarios. - Strong analytical, problem solving, and critical thinking skills. - Professional, patient centered communication style. - Ability to balance patient advocacy with payer compliance and regulatory requirements. - Bachelor’s degree in business, healthcare, or related field or equivalent combination of education and experience required. - 2+ years of experience in the O&P industry utilizing EMR systems. - Prior experience and working knowledge of Commercial, Medicare, & Medicaid Insurances including authorizations, appeals/denials. - Proficient with Microsoft Office, Opie/Nymbl EMRs, ICD10 coding, medical terminology Why You’ll Feel Good Working Here We believe people do their best work when they feel good—personally and professionally. That’s why we offer: - A culture rooted in trust, empathy, and Nordic-inspired flat hierarchies - Tailored onboarding and a buddy system to help you feel at home from day one - Continuous learning through e-learning, training, and language courses - A “you” culture where everyone—from interns to executives—is treated with respect - Competitive Compensation Packages - Medical, Dental, and Vision Benefits - 401(k) Retirement Plan with employer matching contribution - 9 paid holidays - 13 vacation days, birthday and two (2) volunteer days  - 8 sick days within your first year of employment - Paid Parental Bonding The US hourly range for this full-time position is $29.38 - $31.25/hr + bonus + benefits. Our salary ranges are determined by role, level, and location. The range displayed on each job posting reflects the minimum and maximum target for new hire salaries. Within the range, individual pay is determined by work location and additional factors, including job-related skills, experience, and relevant education or training. Your recruiter can share more about the specific salary range for your preferred location during the hiring process. Please note that the compensation details listed in US role postings reflect the base pay only, and do not include bonus, equity, or benefits. ForMotion is a global network of Orthotic & Prosthetic patient care clinics providing exceptional care through award-winning mobility solutions and world-class healthcare professionals. Embla Medical is an equal opportunity employer and makes employment decisions on the basis of merit. We want to have the best available individual in every job. Embla Medical's equal opportunity policy prohibits all discrimination (based on race, color, creed, sex, religion, marital status, age, national origin or ancestry, physical disability, mental disability, military service, pregnancy, child birth or related medical condition, actual or perceived sexual orientation, or any other consideration made unlawful by local laws around the world). Embla Medical is committed to complying with all applicable laws providing equal employment opportunities. This commitment applies to all individuals involved in the operations of Embla Medical and prohibits discrimination by any emplo​yee of Embla Medical, including supervisors and co-workers. Important Warning: Beware of fraudulent recruiters impersonating our company. Please take extra caution when asked for any sensitive personal information, such as social security numbers or bank account details. We will never ask you for any form of payment during the recruitment process. Please make sure you refer to our official website.

Related Categories

Related Job Pages

More Claims Specialist Jobs

Dent Wizard International logo

Claims Coordinator

Dent Wizard International

The leaders in automotive reconditioning🛠️

Claims Specialist105 days ago
OtherRemoteTeam 1,001-5,000Since 1983H1B No Sponsor

• Dispatch over 750 vehicles weekly using internal technology to technicians and/or third-party locksmiths. • Manage and update claims within the portal. • Follow up with technicians daily to provide accurate ETAs to customers on open claims. • Verify pictures and invoicing for accuracy before uploading to the customer via the portal. • Request voids and rebill claims when documentation is incorrect to ensure proper closure. • Provide customer quotes as needed for claim resolution. • Monitor claims cycle time and ensure timely processing. • Communicate cycle time updates with technicians and managers. • Maintain accurate records and documentation for all claims. • Support administrative tasks including data entry, report generation, and system updates. • Audit claim documentation weekly to ensure compliance with customer and internal standards. • Maintain organized digital records for all claims, dispatches, and communications for audit readiness. • Generate weekly and monthly reports on claim volume, cycle time, and resolution rates. • Identify trends in claim delays or errors and recommend process improvements. • Liaise with the Keys Inventory and Dispatch teams to ensure alignment on vehicle availability and technician capacity. • Partner with Customer Service to resolve escalated claims or customer concerns. • Propose updates to claim workflows or dispatch logic based on recurring issues or feedback. • Participate in system enhancement discussions (e.g., Aango portal updates or dispatch tech upgrades). • Train new team members on claim handling procedures and dispatch protocols. • Create and maintain SOPs for claims processing and dispatch workflows. • Other Duties as Assigned

United States
$21 - $26 / hour
Job Closed
The Jonus Group logo

Senior Workers’ Compensation Claims Adjuster

The Jonus Group

The Jonus Group is a leading insurance staffing firm specializing in providing top-tier talent for the insurance industry. We are currently seeking a dedicated and experienced Workers Compensation Claims Adjuster to join a reputable insurance client's Workers Compensation Claims Department.

Claims Specialist106 days ago

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description A well-established Third-Party Administrator (TPA) is seeking an experienced Senior Workers’ Compensation Claims Adjuster to join their team supporting New England accounts. This role is fully remote and requires a seasoned claims professional who can independently manage a complex Vermont workers’ compensation caseload while delivering excellent service to both the client and injured workers. - Manage a full caseload of New England workers’ compensation claims from inception to closure. - Investigate claims thoroughly to determine compensability and appropriate reserves. - Ensure all claims are handled in compliance with New England workers’ compensation laws and regulatory requirements. - Coordinate and communicate with injured workers, employers, medical providers, attorneys, and other stakeholders. - Establish and adjust reserves based on claim developments and exposure. - Direct medical management, including coordination with nurse case managers when appropriate. - Evaluate claims for settlement opportunities and participate in negotiations when necessary. - Manage litigated claims, working closely with defense counsel to develop strategies and control costs. - Maintain accurate claim documentation and provide timely claim updates to the client. - Deliver high levels of customer service to a dedicated client account while meeting all service standards and KPIs. Qualifications - 5+ years of Workers’ Compensation Claims Adjusting experience, with either MA, CT, NH, VT, ME, or RI claim handling required. - Strong understanding of New England Workers’ Compensation regulations and claims procedures. - Experience handling complex and litigated claims. - Prior experience working for a TPA or insurance carrier preferred. - Strong organizational, analytical, and negotiation skills. - Ability to manage a full caseload independently in a remote work environment. - Active adjuster license or ability to obtain quickly. Requirements - Strong knowledge of New England workers’ compensation statutes. - Proven experience handling litigated and complex claims. Benefits - Compensation: $80,000 - $95,000/year - Annual Bonus Potential - 100% Remote Work Environment - Comprehensive benefits package - Opportunity to support a stable, long-term dedicated account - Collaborative and supportive claims leadership team

United States
Job Closed
Assurant logo

Property Liability Claims Adjuster

Assurant

Helping people thrive in a connected world.

Claims Specialist106 days ago
OtherRemoteTeam 10,001+Since 1892H1B Sponsor

Manages an assigned case load of low to moderate Homeowners Liability, specifically Renters and Condo, with a typical exposure of up to $20,000 involving non-litigated matters from the investigation of the claim through the resolution. This includes making decisions about liability/compensability and negotiating settlements within the policy limits to protect our policy holder and client. The role interacts with policy holders, claimants, plaintiff attorneys, coverage & defense counsel, and other third parties throughout the claims management process. Responsibilities: - Manages an inventory of claims to evaluate compensability/liability. - Establishes action plan based on case facts, best practices, protocols, regulatory issues, and state laws. - Maintains current knowledge of court decisions which may impact the claim on principles or practices. This may require attendance at various seminars or training sessions. - Plans and conducts investigations of claims to confirm coverage and to determine negligence, liability, compensability, and damages. - Assesses policy coverages and notifies insured of any issues; determines and establishes reserve requirements for both indemnity and expense on a regular basis and makes recommendations to set reserves at appropriate level for claims outside of authority level. - Prepares comprehensive reports as required by Clients/Brokers and participates in meetings with Clients and Brokers on specific claims. - Identifies and communicates specific claim trends and policy issues to management and underwriting. - Assess actual damages associated with claims and conducts negotiations within assigned authority limits to settle claims. - Proven interpersonal, analytical, and decision-making skills to effectively negotiate and settle claims. - Demonstrated strong negotiation skills. - Knowledge of legal liability, joint & several laws required. - Able to demonstrate abilities to be a self-starter and autonomous worker. Minimum Qualifications: - Adjuster’s license is required for all states where adjuster licensing is applicable - Bachelor’s degree with 3 years of property damage liability claims experience. - Expert level knowledge of specific state contributory and comparative negligence laws and joint & several laws. - Excellent verbal and written skills to communicate internally and externally. - Excellent critical thinking and problem-solving skills. - Strong organizational and time management. - Ability to multi-task in a fast-paced environment. Pay Range: $56,000 - $65,000 Any posted pay range considers a wide range of compensation factors, including candidate background, experience, and work location, while also allowing for salary growth within the position. Pay Range: $56,200.00 - $94,100.00 Any posted pay range considers a wide range of compensation factors, including candidate background, experience and work location, while also allowing for salary growth within the position. If there is no posting end date listed then this is a pipeline requisition, and we will continue to collect applications on an ongoing basis. Helping People Thrive in a Connected World Connect with us. Bring us your best work and your brightest ideas. And we’ll bring you a place where you can thrive. Learn more at jobs.assurant.com. For U.S. benefit information, visit myassurantbenefits.com. For benefit information outside the U.S., please speak with your recruiter. What’s the culture like at Assurant? Our unique culture is a big reason why talented people choose Assurant. Named a Best/Great Place to Work in 15 countries and awarded the Fortune America’s Most Innovative Companies recognition, we bring together top talent around the world. Although we have a wide variety of skills and experiences, we share common characteristics that are uniquely Assurant. A passion for service. An ability to innovate in practical ways. And a willingness to take chances. We call our culture The Assurant Way. Company Overview Assurant is a leading global business services company that supports, protects, and connects major consumer purchases. A Fortune 500 company with a presence in 21 countries, Assurant supports the advancement of the connected world by partnering with the world’s leading brands to develop innovative solutions and deliver an enhanced customer experience through mobile device solutions, extended service contracts, vehicle protection services, renters insurance, lender-placed insurance products, and other specialty products. Equal Opportunity Statement Assurant is an Equal Employment Opportunity employer and does not use or consider race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or any other characteristic protected by federal, state, or local law in employment decisions. Job Scam Alert Please be aware that during Assurant's application process, we will never ask for personal information such as your Social Security number, bank account details, or passwords. Learn more about what to look out for and how to report a scam here.

United States
$56.2K - $94.1K / year
Job Closed

A Top Workers Compensation Defense and Civil Litigation Firm Seeks a seasoned WC Defense Attorney! This Jobot Job is hosted by: Chris De Armas Are you a fit? Easy Apply now by clicking the "Apply" button and sending us your resume. Salary: $140,000 - $210,000 per year A bit about us: A Top Workers Compensation Defense and Civil Litigation Firm Seeks a seasoned WC Defense Attorney! We have offices in LA County, OC, SD, Central Coast, Inland Empire and Fresno! Why join us? A Top Workers Compensation Defense and Civil Litigation Firm Seeks a seasoned WC Defense Attorney! Job Details Job Details: We are seeking a highly skilled and experienced Workers Compensation Defense Attorney to join our dynamic team. This position is remote and offers an exciting opportunity to work on a variety of challenging cases. Our ideal candidate is a self-starter with a strong work ethic, excellent problem-solving skills, and a passion for defending the rights of employers in workers' compensation cases. This role involves handling all aspects of workers' compensation defense, civil litigation, fraud, insurance coverage issues, employment law, labor law, wrongful termination, harassment, ADA, and employee handbooks. Responsibilities: 1. Responsible for managing a caseload of workers' compensation cases, from inception through resolution. 2. Develop and implement defense strategies, conduct discovery, take and defend depositions, draft and argue motions, and represent clients at hearings, mediations, and trials. 3. Conduct legal research and provide legal analysis on complex issues related to workers' compensation, employment law, labor law, and insurance coverage. 4. Handle all aspects of civil litigation, including drafting pleadings, conducting discovery, and representing clients in court. 5. Investigate and defend against fraud claims. 6. Advise clients on employment law issues, including wrongful termination, harassment, and ADA compliance. 7. Assist in the development and revision of employee handbooks to ensure compliance with state and federal laws. 8. Maintain up-to-date knowledge of changes in workers' compensation laws and regulations. 9. Provide exceptional customer service to clients, including timely updates on case status and legal advice in understandable terms. 10. Collaborate with other attorneys, paralegals, and support staff to ensure efficient and effective case management. Qualifications: 1. Juris Doctorate from an accredited law school. 2. Admission to the California State Bar and in good standing. 3. Minimum of 3 years of experience in workers' compensation defense, civil litigation, OR employment law. 4. Proven track record of successfully defending clients in workers' compensation cases. 5. Strong knowledge of workers' compensation laws and regulations, civil litigation procedures, and employment laws. 6. Experience in handling insurance coverage issues, fraud investigations, and labor law issues. 7. Excellent legal research, analytical, and problem-solving skills. 8. Strong oral and written communication skills, with the ability to communicate complex legal concepts in understandable terms. 9. Ability to manage a high-volume caseload, meet deadlines, and work independently. 10. Proficiency in using legal research software and Microsoft Office Suite. Interested in hearing more? Easy Apply now by clicking the "Apply" button. Jobot is an Equal Opportunity Employer. We provide an inclusive work environment that celebrates diversity and all qualified candidates receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, age (40 and over), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. Jobot also prohibits harassment of applicants or employees based on any of these protected categories. It is Jobot’s policy to comply with all applicable federal, state and local laws respecting consideration of unemployment status in making hiring decisions. Sometimes Jobot is required to perform background checks with your authorization. Jobot will consider qualified candidates with criminal histories in a manner consistent with any applicable federal, state, or local law regarding criminal backgrounds, including but not limited to the Los Angeles Fair Chance Initiative for Hiring and the San Francisco Fair Chance Ordinance. Information collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal. By applying for this job, you agree to receive calls, AI-generated calls, text messages, or emails from Jobot, and/or its agents and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy here: jobot.com/privacy-policy

United States
Job Closed