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.
Under supervision, this position is responsible for processing and adjudicating 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.JOB REQUIREMENTS:
* High School Degree or GED.
* 3 years experience in a customer service role in a health insurance or medical environment
* 2 years experience processing claims and utilizing a claims payment system.
* Knowledge of medical terminology to include coding.
* Experience and skills to analyze claims processing issues 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:
* Blue Chip claims payment experience.
* Bilingual English/Spanish.
* Knowledge of OR experience with Medicaid.
Compensation: $19.62 - $32.84
Exact compensation may vary based on skills, experience, and location
HCSC Employment Statement:
We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
To learn more about available benefits, please click https://careers.hcsc.com/totalrewards
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