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Summary: This role is a remote, work from home position. The Claims Resolution Specialist will work Monday through Friday, standard business hours. The team works on an Eastern Time schedule. Equipment is provided, but the use of a personal phone will be required to place outbound calls to insurance carriers. Organizational Impact: In this role for Digitech, you are our brand ambassador for our clients and the patients that they serve. You impact your line of business by ensuring all insurance rules, regulations, and timely filing limits are adhered to and identifying and addressing issues and finding resolutions. Essential Duties and Responsibilities: - Work claims that are pending, are unable to be released or have been denied or incorrectly paid by Insurance carriers. - Review claims that have been put on hold, working to identify causes and address issues causing them to remain on hold. - Work denials aiming to identify why claims have been denied, and handle follow-up accordingly. - Provide insurance companies with additional information as necessary to process a claim correctly and/or send an appeal. - Handle all correspondence via mail, email, and any necessary refunds. - Performs other duties as assigned by management. Skills and Experience Desired: - Strong computer skills with a basic understanding of MS Outlook, Word, and Excel. - Minimum typing speed of 40 wpm. - Ability to handle large volumes of work while meeting tight deadlines. - Experience in an environment where calls were monitored and scored as well as metrics applied to individual performance is helpful. - Ability to deal calmly and effectively with situations via telephone while maintaining and promoting a positive company image. - Excellent communication skills, both written and verbal. Able to present information and solutions in a professional and courteous manner. - Excellent attention to detail and accuracy. - Able to organize and prioritize tasks in order to complete all work assigned.

- Reviews level 1 appeals cases and ensures that information is accurate. - Forwards appeals to CMS entity for further review. - Investigates and resolves member and practitioner issues. - Works within broad guidelines with little oversight. Use your skills to make an impact Required Qualifications - 1+ years of grievances and/or appeals experience. - Data entry experience. - Intermediate proficiency with Microsoft Word and Excel. - Experience in a production driven environment. - Experience handling multiple projects and assignments as directed by management. - Capacity to maintain confidentiality and work independently in support of the department. - Virtual training will start on day one and be Monday – Friday, 8 am – 4:30 pm EST. Following training, candidates must be able to work an 8-hour shift, 5 days/week, Sunday through Saturday between 8am EST to 7pm EST. Shift will be assigned during training. - Weekend work may be required based on business needs. There is a 5% shift differential for weekend work. Preferred Qualifications - Associate or bachelor’s degree. - Previous inbound call center or related customer service experience. - 2 - 4 years of grievance and/or appeals experience. - Previous experience processing medical claims. Additional Information - Workstyle: remote, work from home or in office. - Work Location: must reside in Central or Eastern Standard Time Zone (CST or EST). - Work Schedule: must be able to work an 8-hour shift, 5 days/week, Sunday through Saturday between 8am EST to 7pm ES