Keenan has an exciting career opportunity for a Claims Appeals Specialist. The Claims Appeals Specialist is responsible for responding promptly to claims appeals within ERISA/DOL guidelines, plan documents, and Keenan’s policies and procedures. The Appeals Specialist will also research, track and report trends for appeals and discuss with clients to ensure consistency with the claims appeals process.  

Keenan is a successful insurance brokerage and consulting firm meeting the insurance needs of hospitals, public entities and California school districts. Keenan specializes in providing consulting services in the areas of: employee benefits, workers' compensation, loss control, financial, and property & liability. We have seen continuous growth and success, and are positioned to lead the industry into the 21st century. Keenan continues to grow at a rapid pace, and so do the opportunities for our current and future employees.

• Research and respond to claims appeals according to regulatory guidelines and Keenan procedures.
• Communicate with members and providers with the appeal determination.
• Observe and report trends related to appeals.
• Provide customer service to clients, members and providers regarding appeal status updates, handling questions, responding to complaints and inquiries.
• Adjust claims previously processed according to appeal determinations, determine appropriate action for reversal and/or reprocessing, request refunds, compose and distribute any other necessary correspondence.
• Coordinate with clients and external review partners, as well as internal resources during the appeal determination process. Document any interactions and decisions throughout the process.
• Follow-up on pending items related to appeals, review claim reports and call logs to determine necessary action, request additional information as needed, bring closure to claims when requested data has not yet been received.
• Provide backup support for claims processing functions as required.
• Other duties as assigned.

• Minimum of five (5) years of group medical claims experience required.
• Bachelor’s degree preferred.
• Knowledge of medical terminology, familiarity with standard reference materials, required. 
• Some experience managing and responding to claim appeals. 
• Excellent problem-solving, written, and verbal communication skills. 
• Proficient in Microsoft Outlook, Excel, PowerPoint and Word.

• Adept at accessing business data from the Internet when required.

To help you make the best decision for your personal growth, it’s important to us to share a glimpse of what we offer our top asset, our people:   

• Competitive base salary.   
• Generous 30+ Days Comprehensive Paid Time Off Package inclusive of Paid Time Off, 10 Company Holidays, 2 Floating Holidays, 5 Sick Days, and 2 Volunteer Days.
• Health benefit options with you in mind; 5 affordable medical plan options with rates based on your salary, company paid HSA contribution with eligible HSA plan selection, 2 dental plan options offering orthodontia coverage and 3 cleanings per year, and 2 vision plan options.    
• Company match 401(k) plan – 50% up to 6%!   
• Support of your fitness wellness goals! We offer up to 75% off at over 11,000 gyms and fitness centers.    
• Opportunity to prioritize your mental health with 24/7 access to licensed therapists.   
• Pet benefits & discounts.    
• Access to our Employee-led Resource Groups (ERGs) that lend a voice to the variety of demographics represented throughout our company.

Compensation:

The target salary range for this position is $52,000 to $62,400 (US Dollar) annually. The actual salary will vary based on applicant’s education, experience, skills, and abilities, as well as internal equity and alignment with market data. The salary may also be adjusted based on applicant’s geographic location.

Accretive is a collection of elite specialty and wholesale agencies supported by experienced industry leaders. Our expertise is broad, and our innovative culture runs deep. We value relationships above all else and consistently deliver best in class customized solutions and service you can trust.

Accretive is passionate about fueling our clients’ innovation and growth. That makes us the perfect place for creative, dynamic people who want to grow their career while helping businesses, families and people thrive.  We are proud to be one of the largest brokers in the country, but we’re even prouder of the honest, caring relationships that our employees build with our clients every day.

Working with us will give you the opportunity to do work that matters while you learn with us, advance with us, and most importantly, grow with us. Accretive is committed to embracing diversity, equity and inclusion to create a workplace that welcomes and thrives on the unique experiences, perspectives and contributions of all team members. Accretive is bringing the best people and most diverse talent forward to drive growth, innovate and think bigger!