Appeals Specialist I

Posted 9 Hours Ago
Be an Early Applicant
Pinecrest, FL
Entry level
Healthtech • Insurance
The Role
The Appeals Specialist I processes, organizes, and coordinates materials related to appeals across various business lines while responding to inquiries about appeals from members and other authorized representatives. The role requires accurate letter and update sending, entry of appeals into databases, and may involve travel including overnight stays.
Summary Generated by Built In

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.

Job Summary

Under Supervision, This Position Is Responsible For Processing, Organizing, And Coordinating All Materials And Information Relating To Processing Appeals For All Lines Of Business Following Federal, State, And Accreditation Requirements; And For Accurately Responding By Telephone, In Person, Or Through Correspondence To All Inquiries Involving Requests For Appeals From Members, The Department Of Labor, Or Erisa, Providers, Or A Member Authorized Representative; Sending Letters And Updates According To The Case Requirements; And Entry Of Appeals Into The Appropriate Database. Ability To Travel, Including Overnight Stays.

JOB REQUIREMENTS:
* High School Degree or GED.
* 1 year experience in a customer service role in a health insurance or medical environment
* Analytical, problem solving and research skills.
* Organizational skills to accommodate large volume of reference materials combined with time management skills to achieve accessibility to callers.
* Verbal and written communication skills to clearly express oneself in a well-modulated tone with correct grammar and attention to enunciation.
* Experience working both independently and in a team environment to meet deadlines according to regulations
* Ability to travel, including overnight stays
PREFERRED JOB REQUIREMENTS:
* BlueChip claims payment experience.
* Medical terminology.
* Knowledge of appeals processing.
* Ability to think clearly and maintain a professional, poised attitude under pressure.
* Detail oriented.
* Bi-lingual Spanish speaking.


Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!


HCSC Employment Statement:

We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, 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.

Base Pay Range$17.20 - $27.15

The Company
HQ: Chicago, IL
13,563 Employees
On-site Workplace

What We Do

Imagine Something New, Something Different.

Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), is the largest customer-owned health insurer in the nation and the fourth largest overall. Operating through our Blue Cross and Blue Shield Plans in Illinois, Montana, New Mexico, Oklahoma and Texas (as well as a variety of affiliates and subsidiaries,) we are expanding access to high-quality, cost-effective health care. We are equipping members with information and tools so they can make the best health care decisions for themselves and their families.

HCSC is continuously recognized as an employer committed to community, diversity and inclusion, training and development.

HCSC is committed to pioneering the health care space in ways as effective as they are creative. If you are passionate about the impact you want to have through your work, with a desire to apply innovative thinking to new and emerging challenges, we encourage you to learn more about HCSC.

Learn about what we stand for, how we work and the difference we’re making in the lives of our 15 million members. Join HCSC and discover what new ways of thinking can mean for you, your community, our customers and our organization.



Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.

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