[Hiring] Appeals Specialist II @Health Care Service Corporation

Role Description

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. This role involves responding, by phone, in person, or in writing, to all inquiries involving members' requests for appeals. May train and mentor less experienced appeals specialists.

Qualifications

• 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 customers based on knowledge of federal, state, and NCQA guidelines.
• Experience and skills to organize tasks and accommodate large volumes of reference materials.
• Experience and skills to understand fine details of customer complaint issues.
• Verbal and written communication skills.

Requirements

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

Benefits

• 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.
• Other incentives.

Company 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.