What are the responsibilities and job description for the Appeals Specialist II position at Blue Cross Blue Shield of IL, MT, NM, OK & TX?
NOTE: THIS IS A UNION POSITION
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 lessexperienced 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 claims processing issues and assist customer based on knowledge of federal, state, and NCQA guidelines
- 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.
- Blue Chip claims payment experience.
- 2 year experience processing claims and utilizing a claims payment system.
Union position can be located in Chicago, Downers Grove or Naperville.
- CA
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.
Requirements:
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants.
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