Claims Appeals Specialist

About the role

Unified Group Services is seeking a full-time Claims Appeals Specialist to join our team in Anderson, IN. This is an exciting opportunity for a detail-oriented professional who thrives on research, analysis, collaboration, and meaningful work that directly impacts members and clients.

About the company

At Unified Group Services, we take care of the customer, and then some! Established in 1996, we're a proud full-service third-party administrator (TPA) for self-funded group health insurance plans. Our mission is centered on you—whether you're a customer or a team member—because we believe that great service starts with a great culture. We empower our customers with innovative programs, cutting-edge technology, and trusted partnerships that help control healthcare costs while ensuring access to top-tier benefits. Every service we deliver is backed by a professional, experienced team that provides personal attention with speed and care. We don't just talk about our values—we live them, training every employee to uphold the principles that have guided us from the beginning.

Responsibilities

• Investigate and review internal and external appeals related to benefit determinations, Usual & Customary reductions, discount disputes, and eligibility concerns.
• Collaborate closely with internal review vendors and Independent Review Organizations (IROs) to ensure every appeal is handled accurately and efficiently.
• Draft professional response letters to providers, members, representatives, and attorneys.
• Maintain regular communication with claims processors, reinsurers, vendors, providers, members, clients, and legal representatives.

Requirements

• High school diploma or equivalent.
• Proficiency in Microsoft Word, Excel, and Outlook.
• Strong mathematical and analytical skills.
• Exceptional attention to detail.
• Ability to meet critical deadlines.
• Excellent writing skills with strong grammar and punctuation.
• Effective problem-solving and decision-making abilities.
• Self-motivated mindset, adaptability, reliable attendance, and a commitment to supporting team goals are preferred.

Benefits

• Health, dental, and vision insurance.
• 401(k) with company match.
• Education assistance.
• Employee assistance program.
• PTO.
• Growth opportunities.
• HSA/FSA.
• Life insurance.
• Short- and long-term disability coverage.
• Wellness programs.
• Sponsored health clinic.
• Company parties.

Pay

We offer our Claims Appeals Specialist a competitive wage, based on experience.