Independent Dispute Resol Rep

At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career. Come join us and be part of a purpose driven company who is invested in your future! Job Summary This Position Is Responsible For Intake, Processing, Coordinating All Materials And Information Relating To Processing Negotiations And Independent Disputes As Regulated By Federal Or State Regulations.. This Applies To All Plans At Hcsc, All Lines Of Business And All Products.. Additionally, This Position Will Accurately Process And Respond According To The Hcsc Procedures Via The Required Notifications And Provider Resolution.. This Includes Entry Of New Requests Via The Appropriate Database. 1. Complete, organize and oversee the negotiation and IDR process of assigned cases to ensure all receipts are processed accurately and promptly. 2. Complete dispute procedures as assigned such as intake, case creation, package creation, IDR Entity coordination and response, invoice payment coordination or research. 3. Monitor timely case completion according to the statute, through claim adjustment and IDR Entity invoice. 4. Categorizing and routing Host plan disputes via BlueSquared, route to Network per the Department guideline, and acting as the liaison with other units regarding dispute issues. 5. Determine need for obtaining additional information and notifying providers as related to the processing of disputes. 6. Respond to negotiation and dispute requests within designated time requirements. 7. Process notifications timely per the Dispute process for management approval, track timeliness of response, and send follow-up letters if appropriate. 8. Coordinate and maintain system of tracking provider disputes which includes identification and resolution of outcome of the case. 9. Provide support to Supervisor, and reporting needs, Analysts, and Network staff, as necessary. 10. Identify trends and communicate this information to the Supervisor. 11. Communicate and interact effectively and professionally with co-workers, management, customers, etc. 12. Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies. 13. Maintain complete confidentiality of company business. 14. Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested. 15. Ability and possible assignment to complete claims adjustments regarding processing of IDRs or negotiations. 16. Assist in training Customer Advocates when errors are detected within the assigned work. 17. Assist in providing guidance to new team members as directed by management. JOB REQUIREMENTS: • High School Degree or GED. • Analytical, problem solving and research skills. • Organizational skills to accommodate large volume of reference materials combined with time management skills. • Verbal and written communication skills to clearly express oneself; exercises diplomacy. • Experience working both independently and in a team environment to meet deadlines according to regulations • 1 year experience in a customer service role OR in a health insurance or medical environment. • Experience and skills to analyze and assist the provider based on knowledge of federal, state guidelines. • Experience and skills to organize tasks and accommodate large volume of reference materials. PREFERRED JOB REQUIREMENTS: • BlueChip claims payment experience. • Medical terminology. • Ability to think clearly and maintain a professional, poised attitude under pressure. • Detail oriented. • 2-year experience processing claims and utilizing a claims payment system. Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process! HCSC Employment Statement: HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. Join our talent community and receive the latest HCSC news, content, and be first in line for new job opportunities. Join our Talent Community. For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities. Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren’t afraid to make innovative contributions. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you’ll have to improve health care delivery in an open, collaborative environment. HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at 1-866-977-7378 to request reasonable accommodations. Please note that only requests for accommodations in the application process will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "candidate home" to view your job submissions. 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