Remote Health Plan 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

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.