Impactful Member Advocacy & Appeals Specialist II

HMSA; Honolulu (HI); Sur place; USD 45 000 - 65 000; Plein temps

Résumé du poste

HMSA in Honolulu is seeking an Intake Specialist to manage the intake of department cases involving complex confidential issues in a highly time-sensitive environment.

You will handle member and provider calls, faxes, email, and referrals, evaluate information, and ensure case creation within required timeframes. The role also involves analyzing appeals, inquiries, and grievances and triaging cases to provide the best service.

Qualifications

• Handles intake of department cases involving complex confidential issues in a time-sensitive environment.
• Analyzes sensitive member and provider appeals, inquiries and grievances; applies internal policies and procedures.

Responsabilités

• Intake of member and provider calls, faxes, email correspondence, and internal referrals; evaluation of information to determine best course of action; and follow-up with Department staff and internal departments to ensure accurate case creation are completed within required timeframe.
• Triage cases to resolve them upon initial inquiry/intake to best service members and reduce escalations.
• Creates and maintains accurate electronic case files for appeals and grievances within internal policies and regulatory timeframe requirements.
• Handles internal and external customer service calls regarding member or provider appeals or grievance requests; communicates professionally with customers and identifies what is requested.
• Performs all other miscellaneous responsibilities and duties as assigned.

Description du poste

HMSA in Honolulu is seeking an Intake Specialist to manage the intake of department cases involving complex confidential issues in a highly time-sensitive environment.

You will handle member and provider calls, faxes, email, and referrals, evaluate information, and ensure case creation within required timeframes. The role also involves analyzing appeals, inquiries, and grievances and triaging cases to provide the best service.