What are the responsibilities and job description for the Specialist ii position at Health Care Service Corporation?
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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 : *Blue Chip claims payment experience.*2-year experience processing claims and utilizing a claims payment system.*Bilingual English / Spanish.
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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.
Last updated : 2024-05-03
