To learn more about Arkansas Blue Cross and Blue Shield Hiring Policies, please click here. Applicants must be eligible to begin work on the date of hire. Applicants must be currently authorized to work in the United States on a full-time basis. ARKANSAS BLUE CROSS BLUE SHIELD will NOT sponsor applicants for work visas in this position. Arkansas Blue Cross is only seeking applicants for remote positions from the following states: Arkansas, Florida, Georgia, Illinois, Kansas, Louisiana, Minnesota, Mississippi, Oklahoma, South Carolina, Tennessee, Texas, Virginia and Wisconsin. Workforce Scheduling Flex Job Summary Legal Appeals Researcher Specialist assists with organizing and coordinating legal appeals and complaints by efficiently and accurately preparing reports, researching, document gathering, handling inquiries and coordinating work for professional staff. Requirements EDUCATION High school diploma or equivalent. EXPERIENCE Minimum three (3) years' claims processing, claims research experience, or customer service experience required. Familiarity with CPT, ICD-10 and Medical Terminology. Previous experience with Power, CSW, B2, CCI, and Amisys is preferred. ESSENTIAL SKILLS & ABILITIES Microsoft Office Suite ICD 10 and CPT Coding Medical Terminology Medical Claims Processing Researching Confidentiality Professionalism Judgement Interpersonal Communication Multitasking Highly Organized Detail-Oriented Problem Solving Oral & Written Communication Self-Motivated Team Player Ability to work independently. Skills Ability to work independently, Detail-Oriented, Interpersonal Relationships, Microsoft Excel, Microsoft Office, Microsoft PowerPoint, Oral Communications, Problem Solving Responsibilities Coordinates adjustment activities with adjustments, claims processing area, medical directors, attorneys and professional staff., Monitors system queue and provides daily reporting of appeals status., Performs other duties as assigned, Requests and reviews medical records related to appeals research, as requested., Researches complaints utilizing multiple systems and resources. Prepares documentation for appeals filing ensuring timely responses. Certifications Security Requirements This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual. Segregation of Duties Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual. Employment Type Regular ADA Requirements 1.1 General Office Worker, Sedentary, Campus Travel - Someone who normally works in an office setting or remotely and routinely travels for work within walking distance of location of primary work assignment. Arkansas Blue Cross has been named one of central Arkansas’ "Top Work Places" by the Arkansas Democrat-Gazette and has earned a top ranking in the large business category multiple times since 2012. Why? We Love our Employees At Arkansas Blue Cross, we care about the health, wellness, and even education of our employees. We offer many great incentives such as: Tuition reimbursement because we value education. Club Blue, a free, onsite gym to encourage exercise. Green Leaf Grill (onsite cafeteria) to help promote healthy eating. Incentives for wellness education and exercise. We Love the Family Environment The average tenure is 10 years with hundreds of employees having been here 15 years or longer. Truly a family atmosphere. Employees go out of their way to help fellow employees in times of need. We Love our Community At Arkansas Blue Cross, our employees care about their community and work together to help others. Our employees often volunteer at charity walks/runs. If you see a gathering of Blue T-shirts at an event, you are probably seeing our Blue team! Our employees organize fundraising events for a variety of charities. From scheduled casual days, to supply collections, to selling treats for a cause, our employees are always helping others. Whether it is within our state, around the world, or happening to one of our own, when disasters strike, our employees help wherever they are needed. It’s just another way we show that Blue cares.