Appeals Specialist II

HCSC•Tulsa, OK

74d•$18 - $37

About The Position

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. 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 MemberS Requests For Appeals. May Train And Mentor Less Experienced Appeals Specialists.

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.

Nice To Haves

Blue Chip claims payment experience.
2-year experience processing claims and utilizing a claims payment system.
Bilingual English/Spanish.

Responsibilities

Processing And Adjudicating Complex Non-Utilization Management Appeals According To The Appropriate Federal, State, And Ncqa Requirements And Regulations
Responding, By Phone, In Person, Or In Writing, To All Inquiries Involving MemberS Requests For Appeals
Train And Mentor Less Experienced Appeals Specialists