Member Advocacy & Appeals Support Specialist II

Hawaii Medical Service Association; Honolulu (HI); On-site; USD 42,000 - 78,000; Full time

Job summary

Hawaii Medical Service Association is seeking a full-time Administrative Support role within the Member Advocacy and Appeals department. The position provides high-level administrative and clerical support, ensuring efficient intake, case creation, and timely handling of complex member and provider inquiries.

Minimum qualifications include an associate's degree (or equivalent) with 1 year of related experience, plus strong communication skills and solid proficiency in Word, Excel, and Outlook.

Qualifications

• Associate's degree and one year of related experience; or an equivalent combination of education and related work experience.
• Strong verbal and written communication skills
• Basic working knowledge of Microsoft Office applications including Word, Excel, and Outlook.

Responsibilities

• Handles intake processes for department cases involving confidential issues in a time-sensitive environment.
• Intake of member and provider calls, faxes, email correspondence, and internal referrals; evaluate information and ensure timely case creation.
• Conduct analysis of sensitive member and provider appeals, inquiries and grievances and apply internal policies and regulatory requirements.
• Creates and maintains accurate electronic case files for appeals and grievances within policy and regulatory timeframes.

Skills

Communication skills

Education

Associate's degree or equivalent

Tools

Microsoft Office

Job description

#26-6242

Employment Type

Full-time

Exempt or Non-Exempt

Non-exempt [Non-ex.]

Job Summary

Pay Range: $42,000 - $78,000

Note: Individuals typically begin between the minimum to middle of the pay range

Provides high level administrative and clerical support to Member Advocacy and Appeals department.

Minimum Qualifications

• Associate's degree and one year of related experience; or an equivalent combination of education and related work experience.
• Strong verbal and written communication skills
• Basic working knowledge of Microsoft Office applications including Word, Excel, and Outlook.

Duties and Responsibilities

• Handles the intake processes for all Department cases that involve complex confidential issues in a highly time sensitive environment.
  • 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 consistent with information relayed to members/providers and within timeframe required by law, regulation, policy, or other requirement.
  • Conduct analysis of sensitive member and provider appeals, inquiries and grievances and applies internal policies and procedures, contractual provisions, and regulatory requirements.
  • Triage cases to resolve them upon initial inquiry/intake to best service members and reduce cases escalated to Case Resolution Specialists.
• Creates and maintains accurate electronic case files for appeals and grievances from members and providers within the scope of internal policies and procedures, and regulatory timeframe requirements.;.
  • Identifies potential issues when preparing and reviewing electronic cases including case file and program database entry and discusses these with the department supervisor or coordinator.
  • Updates electronic case folder and computer program database.
• Handles internal and external customer service calls regarding member or provider appeals or grievance requests.
  • Is able to handle complex issues and requests by listening for understanding and communicates appropriately and professionally with internal/external customers.
  • Is able to identify what the caller is requesting, and asks questions for understanding, to offer excellent customer service experience.
• Performs all other miscellaneous responsibilities and duties as assigned or directed.

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