MAA Operations Support Specialist

TEKsystems•Honolulu, HI

1d•$23 - $23•Onsite

About The Position

Operations Support Specialist – Healthcare Appeals & Member Advocacy Help Improve the Healthcare Experience for Members Are you detail-oriented, organized, and passionate about helping others? We're seeking an Operations Support Specialist to support a healthcare advocacy and appeals team by ensuring member concerns, appeals, and inquiries are accurately documented, processed, and routed for review. In this role, you'll be the critical first point of contact in the case management process, helping ensure members receive timely support while contributing to operational excellence and regulatory compliance. This opportunity is ideal for professionals with experience in customer service, healthcare operations, insurance, call centers, or administrative support who enjoy working in a fast-paced environment where accuracy and communication matter.

Requirements

2-3+ years of experience in customer service, healthcare operations, call center, administrative support, or a related environment.
Strong verbal and written communication skills.
Excellent attention to detail and organizational abilities.
Experience maintaining accurate records and documentation.
Ability to manage multiple priorities in a fast-paced setting.
Proficiency with data entry, case management systems, and administrative processes.

Nice To Haves

Experience within healthcare insurance, payer operations, or health plan environments.
Familiarity with appeals, grievances, claims, or member services processes.
Case management experience.
Understanding of HIPAA and healthcare compliance requirements.

Responsibilities

Receive and process incoming appeals, grievances, complaints, and advocacy requests.
Create and maintain accurate case records within a case management system.
Review submissions for completeness and ensure required documentation is received.
Verify member information and supporting details.
Route cases to the appropriate teams based on established workflows and guidelines.
Maintain thorough and accurate documentation throughout the intake process.
Answer inbound calls related to appeals, grievances, and member concerns.
Conduct outbound calls to gather additional information and provide updates.
Assist members with understanding submission requirements and next steps.
Deliver compassionate, professional service when handling sensitive situations.
Document all interactions accurately and efficiently.
Process correspondence received through phone, email, fax, mail, and electronic channels.
Digitize, organize, and attach documents to member case files.
Monitor work queues and shared inboxes to ensure timely processing.
Track required communications and case-related activities.
Support inventory management and operational workflow initiatives.
Assist with documentation retrieval and audit preparation.
Adhere to privacy, confidentiality, and regulatory requirements.
Ensure all work meets established service-level expectations and timelines.
Identify potential processing issues and escalate concerns when necessary.
Participate in quality reviews and continuous process improvement efforts.
Partner with customer service, claims, clinical, and operational teams to support member needs.
Escalate urgent situations according to established procedures.
Contribute to departmental projects and workflow improvements.