Appeals and Grievance Support

PacificSource•Springfield, OR

10d

About The Position

Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths. Provide clerical assistance to Appeals and Grievance team in entry and maintenance of case records. Provide high quality customer service to internal and external customers regarding appeals and grievance inquiries. Support member and ensure customer satisfaction.

Requirements

Minimum one year customer service, and/or claims processing, health insurance industry process experience required.
Data entry experience preferred.
High School Diploma or equivalent required.
Requires strong research, analytical and data entry skills.
Must have basic math skills, the ability to work under strict deadlines, and excellent organizational skills.
Accountability
Collaboration
Communication (written/verbal)
Flexibility
Listening (active)
Organizational skills/Planning and Organization
Problem Solving
Teamwork

Nice To Haves

Experience using Facets, OnBase, and other software packages used by PacificSource is strongly preferred.

Responsibilities

Process intake of appeals and grievances into the departments tracking database.
Monitor incoming documents via fax, web, email, USPS and route to appropriate entity in a timely manner and in accordance with department processes
Maintain office supply inventory for the department.
Communicate complex information related to A&G rules and regulations, verbally and in writing, to internal and external customers.
Effectively capture and transcribe meeting minutes.
Work collaboratively in an objective, professional, diplomatic manner with all internal and external customers.
Provide clerical backup for other A&G staff as needed.
Meet department and company performance and attendance expectations.
Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
Perform other duties as assigned.