Appeals Specialist

Optimal Solutions & Technologies (OST, Inc.) is focused on excellence. We specialize in providing Management Consulting, Information Technology, and Research Development and Engineering services.

The fundamental distinction of the OST team is its business knowledge in both the public and private sectors. We serve the aerospace & transportation, association & nonprofit, defense, education, energy, financial, healthcare, and technology & telecommunications industries. OST is successful because we listen to our clients, we learn from our clients, and we know our clients.

The Appeals Specialist

Position Description:

This role demands a meticulous approach to understanding policies, regulations, and the specific circumstances surrounding each case. By acting as a mediator between the entity making the denial and the individual or provider submitting the appeal, the specialist ensures that every appeal is evaluated thoroughly and fairly, based on the merits of the case and applicable guidelines. Through their detailed work, Appeals Specialists contribute to the overall satisfaction and trust of the stakeholders involved, while also maintaining the standards and reputation of the organization they represent.

Principle Duties & Responsibilities:

• Core responsibilities will be focused on the daily processing of claims appeals for the National Flood Insurance Program
• Research and Analysis:
  
  
  
  • Case files and related materials, reach conclusions
  
  
  
  
• Appeal Letter Writing:
  
  
  
  • Prepare written responses in letter or narrative form to formal appeals from policyholders
  
  
  
  
• Case management:
  
  
  
  • Report, track and communicate status and issues, based on client's needs
  
  
  
  
• Documentation Compliance:
  
  
  
  • Maintain current and accurate status notes and data in the system of record and update daily as needed
  • Produce high quality documentation and reports
  • Assist in the preparation and publication of claims appeals reports and deliverables
  
  
  
  
• Training:
  
  
  
  • Complete all mandatory trainings set by OST and Project
  • Maintain awareness of current developments within the NFIP
  • Assist the team as needed including potential cross-training for continuity of operations.
  
  
  
  
• Complete quality control reviews as designated
• Assist with disaster response activities, including the preparation of critical reports
• Identify and report risks in the areas of responsibility
• Work with FEMA staff and insurance industry staff concerning policyholder claims appeals

Required Knowledge, Skills & Abilities:

• Knowledge and experience pertaining to the NFIP, or the flood insurance industry in general; or the casualty insurance industry, as an adjuster or claims examiner, or support to those roles
• NFIP background and experience
• Experience with Excel reporting
• Some understanding of underwriting procedures

Preferred Knowledge, Skills & Abilities:

• Excellent written and verbal communication skills
• Proficiency in MS Office, especially Excel, Word, and PowerPoint
• Highly organized, energetic, creative, passionate, team player
• Detailed-oriented problem solver

Required Education & Experience:

• Bachelor degree required, preferably with significant coursework in business or economics
• 5+ years of successful claim-handling experience at a Property & Casualty insurance company
• Must be US Citizen
• Ability to obtain a public trust security clearance

This is a full time position paying a base salary of $69,000, full benefits, and has possible bonus potential based on merit and performance. To be considered for this position, please apply online with a cover letter and MS Word resume.

OST is an equal opportunity employer. Applicants are considered for positions without regard to race, religion, gender, native origin, age, disability, or any other category protected by applicable federal, state, or local laws.