Appeals and Grievance Support (Monday-Friday)

PacificSource Health Plans•Springfield, OR

4d•Hybrid

About The Position

PacificSource is seeking an Appeals and Grievance Support individual to provide clerical assistance to the Appeals and Grievance team. This role involves the entry and maintenance of case records and providing high-quality customer service to both internal and external customers regarding appeals and grievance inquiries, ensuring member satisfaction. PacificSource is an equal opportunity employer committed to diversity and fostering a work environment where individual differences are appreciated and utilized.

Requirements

Minimum one year customer service, and/or claims processing, health insurance industry process experience required.
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.
Ability to read and comprehend both written and spoken English.
Communicate clearly and effectively.

Nice To Haves

Data entry experience preferred.
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.