at Health Care Service Corporation in Rockford, Illinois, United States
Job Description
At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.
Come join us and be part of a purpose driven company who is invested in your future!
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 Member*S Requests For Appeals. May Train And Mentor Less Experienced Appeals Specialists.
JOB 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.
PREFERRED JOB REQUIREMENTS:
*Blue Chip claims payment experience.
*2-year experience processing claims and utilizing a claims payment system.
*Bilingual English/Spanish.
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
HCSC Employment Statement:
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
