Appeals Examiner

Here we grow again!

Wipro is seeking individuals who combine excellent problem-solving skills with the ability to function effectively both as part of a team or on an individual basis to bring their talent to our team.

Wipro is a leading global IT solutions and services company with over 240,000 dedicated employees serving clients across multiple continents and 66 countries.

We offer a strong compensation package that includes competitive pay and day one benefits. Wipro also offers many opportunities for career advancement within our engaging and exciting culture.

On site 3701 Boardman Canfield Rd., Bldg. B, Canfield Ohio 44406

Work authorization: US Citizen or Green Card only

No relocation

The specialized role of a claim appeal and grievance examiner includes the review of disputes from members and providers tied to how a claim transaction was processed. This team member performs detailed research, collaborates with internal and external vendors when necessary, and prepares the final response to the inquirer relative to outcome.

• Coordinate the review and response of member appeals meeting all Department of Labor, State and client requested guidelines for accuracy, timeliness and documentation.
• Coordinate the review and response to provider disputes meeting all State and client requested guidelines for accuracy, timliness and documentation.
• Work with other responsible teams to assist in the research and response of complaints. Teams may be internal or external.
• Follow all HIPAA guidelines for the release of information.
• Coordinate escalations with medical review and follow-up timely to assure timeframes and client expectations are met.
• Interpret Summary Plan Document language.
• Coordinate the hand off to adjustment team when a dispute is over-turned.
• Other duties as assigned.

• High School/GED required.
• Demonstrate skills in problem solving and benefit plan interpretation.
• Knowledge of CPT codes, ICD10 codes and medical terminology
• Ability to work independently
• PC proficiency
• Average typing ability
• One year's prior experience in health care administration