Appeals Analyst, Associate
About The Position
Guided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience. Some of our offerings include: Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute Annual incentive bonus plan based on company achievement of goals Time away from work including paid holidays, paid time off and volunteer time off Professional development courses, mentorship opportunities, and tuition reimbursement program Paid parental leave and adoption leave with adoption financial assistance Employee discount program Job Description Summary: Provides information management services to the Appeals Department (e.g., routing appeals, data entry, mailing appeal response letters). Assists Senior Appeals Analysts and department management with the substantive work of the Appeals department (e.g., triaging, medical record requests, sending certain appeal letters). Job Description Receives information via document imaging system, customer service inquiries, mail, and Blue Square and reviews to ensure how the information should be handled. Routes information to internal stakeholders (e.g., Written Correspondence, FEP, ITS Host, SIU and Medical Management) and external stakeholders (e.g., Lucet (formerly NDBH), eviCore, Turning Point, EyeMed and OncoHealth). Enters and indexes all appeals in required systems (e.g., Guiding Care, document imaging system). Triages and assigns appeals to staff by type of appeal. Orders Medical records request for appeals, update appeal case file in required systems (e.g., Guiding Care, document imaging system). Communicates with providers to ensure receipt of medical records. Requests claim adjustments when appropriate and retrieves adjusted EOBs. Retrieving and mailing all appeal response letters.
Requirements
- Associate’s degree from a college or university in business administration, health care management, or other relevant academic field or equivalent combination of education and experience
- 2 years of experience at a health insurer researching and responding to customer claim / benefit issues, or a related role providing a working knowledge of health plan benefits, major business systems and operational processes (e.g., Claims Processing, Member Services, Customer Service).
- Intermediate knowledge and skill in the use of Facets and Guiding Care.
- Experience researching, summarizing, and communicating detailed information and analysis
- Ability to effectively communicate with a broad range of individuals and groups, including members, providers and Blue KC employees and senior management on issues related to complaints, grievances or appeals.
- Ability to compose professional business correspondence.
- Ability to define problems, collect data, establish facts and draw valid conclusions.
- Working knowledge of major BCBSKC lines of business (e.g., local insured, BlueCard) and operational processes (e.g., Claims Processing, Member Services, and Customer Service).
Nice To Haves
- Bachelor’s degree in business, finance, accounting, law, health care administration, or other relevant academic discipline; OR four (4) years relevant experience in the health insurance industry
- 4 years of experience at a health insurer researching and responding to customer claims / benefit issues/appeals and grievances
- Working knowledge of BCBSKC member health benefits certificates.
- Thorough knowledge of BCBSKC’s business systems (e.g., Facets, Perceptive, Guiding Care, ITS Host and Home)
- Intermediate knowledge of an ability to use Microsoft Office applications preferred.
- Advanced keyboarding skills.
Responsibilities
- Receives information via document imaging system, customer service inquiries, mail, and Blue Square and reviews to ensure how the information should be handled.
- Routes information to internal stakeholders (e.g., Written Correspondence, FEP, ITS Host, SIU and Medical Management) and external stakeholders (e.g., Lucet (formerly NDBH), eviCore, Turning Point, EyeMed and OncoHealth).
- Enters and indexes all appeals in required systems (e.g., Guiding Care, document imaging system).
- Triages and assigns appeals to staff by type of appeal.
- Orders Medical records request for appeals, update appeal case file in required systems (e.g., Guiding Care, document imaging system).
- Communicates with providers to ensure receipt of medical records.
- Requests claim adjustments when appropriate and retrieves adjusted EOBs.
- Retrieving and mailing all appeal response letters.
Benefits
- Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute
- Annual incentive bonus plan based on company achievement of goals
- Time away from work including paid holidays, paid time off and volunteer time off
- Professional development courses, mentorship opportunities, and tuition reimbursement program
- Paid parental leave and adoption leave with adoption financial assistance
- Employee discount program
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
Associate degree
Number of Employees
501-1,000 employees
