Appeals Specialist II

Health Care Service Corp.; United States; Remote; USD 26,000 - 47,000; Full time

Benefits offered by this job

Health benefits

401(k) plan

Pension plan

Paid time off

Paid parental leave

Disability insurance

Tuition reimbursement

Employee assistance program

Paid holidays

Drug-free workplace

Job summary

Health Care Service Corporation (HCSC) is seeking an Appeals Specialist under supervision to process and adjudicate complex non-utilization management and member appeals in accordance with federal, state, NCQA requirements. The role may involve training and mentoring less experienced staff.

The position requires strong customer service, medical terminology knowledge, and the ability to analyze and resolve issues with attention to detail.

Qualifications

• High School degree or GED required.
• 3 years' experience in a customer service role or health insurance/medical environment.
• Knowledge of medical terminology including coding.
• Ability to analyze and assist customers based on federal/state/NCQA guidelines.
• Ability to organize tasks and manage large volumes of reference materials.
• Strong verbal and written communication skills.

Responsibilities

• Process and adjudicate complex non-utilization management appeals.
• Respond to inquiries by phone, in person, or in writing.
• May train and mentor less experienced Appeals Specialists.

Skills

Customer service experience

Verbal and written communication

Medical terminology knowledge

Ability to analyze issues

Education

High School Degree or GED

Tools

Claims payment system

Job description

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary Under Supervision, This Position Is Responsible For Processing And Adjudicating Complex Non-Utilization. Management Appeals According To The Appropriate Federal, State, And Ncqa Requirements And Regulations; And Responding, By Phone, In Person, Or In Writing, To All Inquiries Involving Member*S Requests For Appeals. May Train And Mentor Less Experienced Appeals Specialists.

JOB REQUIREMENTS:

• * High School Degree or GED.
• * 3 years' experience in a customer service role OR in a health insurance or medical environment.
• * Knowledge of medical terminology to include coding.
• * Experience and skills to analyze and assist customer based on knowledge of federal, state, and NCQA guidelines.
• * Experience and skills to organize tasks and accommodate large volume of reference materials.
• * Experience and skills to understand fine details of customer complaint issues.
• * Verbal and written communication skills.

PREFERRED JOB REQUIREMENTS:

• * Claims experience.
• * 2-year experience processing claims and utilizing a claims payment system.
• * Bilingual English/Spanish.

Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. This position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii.

HCSC Employment Statement: We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. We are a drug-free and smoke-free workplace. Employment may be contingent upon successful completion of drug screening in accordance with applicable law.

Base Pay Range $19.13 - $34.17 Exact compensation may vary based on skills, experience, and location.

For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities. Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren't afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you'll have to improve health care delivery in an open, collaborative environment.

HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants. If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at 1-866-977-7378 to request reasonable accommodations. Please note that only requests for accommodations in the application process will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "candidate home" to view your job submissions.