Appeals Specialist II
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Job Description
Appeals Specialist II processing complex health insurance appeals for HCSC. Responding to member inquiries and supporting compliance with federal, state, and NCQA requirements.
Responsibilities:
- Process and adjudicate complex non-utilization management appeals according to applicable federal, state, and NCQA requirements and regulations.
- Respond by phone, in person, or in writing to inquiries involving members’ requests for appeals.
- May train and mentor less experienced Appeals Specialists.
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.
- This position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii.
Benefits:
- Curated development plans and professional development
- 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
- Annual incentive bonus plan, subject to plan terms and conditions
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