What are the responsibilities and job description for the Appeals and Grievance Support position at PacificSource?
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PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.
Diversity and Inclusion : PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.
Provide clerical assistance to Appeals and Grievance team in entry and maintenance of case records. Provide high quality customer service to internal and external customers regarding appeals and grievance inquiries. Support member and ensure customer satisfaction.
Essential Responsibilities :
- Process intake of appeals and grievances into the departments tracking database.
- Monitor incoming documents via fax, web, email, USPS and route to appropriate entity in a timely manner and in accordance with department processes
- Maintain office supply inventory for the department.
- Communicate complex information related to A&G rules and regulations, verbally and in writing, to internal and external customers.
- Effectively capture and transcribe meeting minutes.
- Work collaboratively in an objective, professional, diplomatic manner with all internal and external customers.
Supporting Responsibilities :
Work Experience :
Minimum one year customer service, and / or claims processing, health insurance industry process experience required. Data entry experience preferred.
Education, Certificates, Licenses :
High School Diploma or equivalent required.
Knowledge :
Requires strong research, analytical and data entry skills. Experience using Facets, OnBase, and other software packages used by PacificSource is strongly preferred. Must have basic math skills, the ability to work under strict deadlines, and excellent organizational skills.
Competencies : Adaptability
Building Customer Loyalty
Building Strategic Work Relationships
Building Trust
Continuous Improvement
Work Standards
Contributing to Team Success
Planning and Organizing
Environment :
Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.
Skills :
Accountability, Collaboration, Communication (written / verbal), Flexibility, Listening (active), Organizational skills / Planning and Organization, Problem Solving, Teamwork
Our Values
We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business :
Physical Requirements : Stoop and bend. Sit and / or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer : This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
