Appeals Specialist II

Job not on LinkedIn

🔥 5 minutes ago

🇺🇸 United States – Remote

💵 $19 - $34 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Health Care Service Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Health Care Service Corporation is an independent licensee of the Blue Cross Blue Shield Association, serving nearly 23 million people across the United States with a wide range of health benefit solutions. The company provides health coverage options for various groups, including employers, individuals, families, as well as Medicare and Medicaid plans. In addition to health insurance, HCSC offers services such as pharmacy solutions, life and dental insurance, and health data technology. With nearly a century of experience, HCSC is dedicated to improving access to quality care, enhancing health outcomes, and reducing costs while maintaining a deep commitment to its members and local communities.

📋 Description

• Process and adjudicate complex non-utilization management appeals according to applicable federal, state, and NCQA requirements and regulations. • Respond by phone, in person, or in writing to 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. • This position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii.

🏖️ Benefits

• Curated development plans and professional development • Health and wellness benefits • 401(k) savings plan • Pension plan • Paid time off • Paid parental leave • Disability insurance • Supplemental life insurance • Employee assistance program • Paid holidays • Tuition reimbursement • Other incentives • Annual incentive bonus plan, subject to plan terms and conditions

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume