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.

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.

* Prefer background as a medical assistant or prior Medicare Claims experience

*3-5 years’ experience in Medicare Advantage Health Plans or related experience in a healthcare setting handling complex inquiries and requests for service.
* 2-year experience processing claims and utilizing a claims payment system.

* Knowledge and understanding of Appeals Processing and business/operating processes and procedures.
* Bilingual English/Spanish.

Compensation: $18.10 - $37.10

Exact compensation may vary based on skills, experience, and location

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

To learn more about available benefits, please click https://careers.hcsc.com/totalrewards