Appeals Specialist II
Коротко о вакансии
Компания HCSC ищет специалиста по рассмотрению апелляций клиентов. Сотруднику предстоит обрабатывать и разрешать сложные неэкспертизные жалобы в соответствии с федеральными законами и стандартами NCQA. В обязанности входит консультирование членов плана письменно, по телефону или лично, а также обучение менее опытных коллег. Позиция предполагает глубокое погружение в детали жалоб и работу с большими объемами документации.
- Роль и уровень
- Специалист по апелляциям, middle (Appeals Specialist II)
- Формат работы
- удалёнка
- География
- США (континентальная часть, исключая Калифорнию, Нью-Йорк, Аляску и Гавайи)
- Зарплата
- 19,13 — 34,17 $ — по данным Himalayas
- Ключевые требования
- Диплом High School или GED
- 3 года опыта в клиентском сервисе или медицине
- Знание медицинской терминологии, включая кодирование
- Понимание нормативных требований штатов, федеральных правил и NCQA
- Развитые навыки устной и письменной коммуникации
- Кому подойдёт
- Вакансия подойдет специалистам по клиентской поддержке в медицинской или страховой сфере, имеющим опыт разбора спорных ситуаций и знающим отраслевые стандарты.
Пересказ openqareer по тексту работодателя. Ниже — оригинал объявления.
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Job Summary
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; And Responding, By Phone, In Person, Or In Writing, To All Inquiries Involving Member*S Requests For Appeals. May Train And Mentor Less Experienced Appeals Specialists.
JOB 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.
PREFERRED JOB REQUIREMENTS: *Claims experience. *2-year experience processing claims and utilizing a claims payment system.
*Bilingual English/Spanish.
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
Pay Transparency Statement:
At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From 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, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting .
The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.
This position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii .
HCSC Employment Statement:
Base Pay Range
$19.13 - $34.17
Exact compensation may vary based on skills, experience, and location.
Originally posted on Himalayas
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