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Appeals Coordinator

ComPsych
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About ComPsych

ComPsych® Corporation is the world's largest provider of employee assistance programs (EAP) and is the pioneer and worldwide leader of fully integrated EAP, behavioral health, wellness, work-life, HR, FMLA and absence management services under its GuidanceResources® brand. ComPsych provides services to more than 45,000 organizations covering more than 100 million individuals throughout the U.S. and over 160 countries. By creating “Build-to-Suit” programs, ComPsych helps employers attract and retain employees, increase employee productivity and improve overall health and well-being.

Job Summary

The Appeals Coordinator manages and complies with appeals regulations established by ERISA and establishes a process that needs to be followed to ensure our compliance with the appeal rules of ERISA.

Primary Responsibilities

  • Log and record all appeals in a timely manner to ensure that proper record keeping of timeframes are maintained.

  • Investigate all appeals to determine the nature and cause of issue and make a decision on the outcome of that investigation.

  • Follow up with all parties to the facility, provider or client on any outstanding questions in a professional and timely manner via telephone or mail.

  • Document all decisions in the proper location timely and in a clear and concise method

  • Send decision correspondences to appropriate parties within the required time periods.

  • Collect, submit and track the process of reviewing all medical records to Clinical Reviewers that includes the Clinical Director, Medical Director or outside firm.

  • Report on a weekly, monthly and quarterly basis all appeal activity to the SVP of Quality and the Appeals Committee in a format approved by the Committee.

  • Coordinate all second level appeals with Customers in a professional and timely manner.

  • Negotiate a per-case rate with Non-participating providers when necessary.

  • Perform four quality initiatives per year as determined.


  • Claims or Customer Service experience in a medical/healthcare or relevant field

  • Understanding of ERISA and/or appeals processes a plus

  • Bachelor's degree

  • Must be able to work on-site in the Chicago Office

  • Stable Work History Required

Additional Benefits We Offer

  • Our US headquarters are located in one of Chicago's premier buildings, the NBC Tower. Nestled between Michigan Avenue and Lake Michigan, ComPsych's downtown Chicago location is easily accessible by public transportation and has plenty of parking nearby.

  • Beautiful work environment

  • Full benefits package with paid holiday and vacation time

  • Breakfast on Fridays and snacks/juice daily

EOE/AA/M/F/Vet/Disability

ComPsych Corporation maintains a drugfree workplace.

Apply Here: http://www.Click2apply.net/fc6tynwb3cs2h9hg

PI101733659