Our Grievance & Appeals Specialist I act as the primary investigator for member appeals and grievances including analyzing, researching, and managing inventories. Responding to member/provider requests within regulatory requirements and plan policy.
We're looking for Grievance & Appeals Specialist I with:Required Experience: 3 years’ health industry or related experience
What a day of a Grievance & Appeals Specialist I would look like:- Ensure cases are accurately classified and categorized.
- Prepare comprehensive case histories for presentation and consideration at committee meetings and audits.
- Determines if additional information or documentation is needed to make appropriate decisions.
- Interpret and apply business rules, policies and contract.
- Prepare appeal cases to send to an independent specialty reviewer.
- Present appeal case information to a multi-department committee.
- Good verbal and written communication skills
- Medical terminology
- Familiar with ICD10 and CPT coding
- Experience with Individual and Group Contract language
- Customer Service or Claims processing experience preferred
As of the date of this posting, a good faith estimate of the current pay range is $23.63 to $33.09. The position is eligible for an annual incentive bonus (variable depending on company and employee performance).
The pay range for this position takes into account a wide range of factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, travel requirements, internal equity, business or organizational needs, and alignment with market data. At Blue Cross of Idaho, it is not typical for an individual to be hired at or near the top range for the position. Compensation decisions are dependent on factors and circumstances at the time of offer.
We offer a robust package of benefits including paid time off, paid holidays, community service and self-care days, medical/dental/vision/pharmacy insurance, 401(k) matching and non-contributory plan, life insurance, short and long term disability, education reimbursement, employee assistance plan (EAP), adoption assistance program and paid family leave program.
We will adhere to all relevant state and local laws concerning employee leave benefits, in line with our plans and policies.
Reasonable accommodationsTo perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
Skills Required
- Three years of health industry or related experience
- Good verbal and written communication skills
- Knowledge of medical terminology
- Familiarity with ICD-10 and CPT coding
- Experience with individual and group contract language
- Customer service or claims processing experience
Blue Cross of Idaho Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Blue Cross of Idaho and has not been reviewed or approved by Blue Cross of Idaho.
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Healthcare Strength — Feedback suggests medical, dental, vision and mental‑health coverage are a standout, with affordable PPO/HSA options often cited. Role postings and third‑party summaries describe comprehensive plan choices that employees value.
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Retirement Support — Feedback suggests a 401(k) with a company match is a core element, with mentions of an additional non‑contributory employer contribution. This indicates meaningful long‑term savings support as part of total rewards.
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Leave & Time Off Breadth — Role postings specify paid time off, paid holidays, a community service day and a self‑care day. Paid family leave, adoption assistance and an EAP further extend time‑off and wellbeing supports.
Blue Cross of Idaho Insights
What We Do
Since 1945, we’ve taken our role as an Idaho-based health insurance company to heart. While the health insurance marketplace has experienced lots of change in recent years, we haven’t. As a not-for-profit, we’re mission-driven to help connect Idahoans to quality healthcare that is affordable and build strong networks and services with our customers in mind. With an annual economic impact of $456 million (in 2016), we lead the state and industry in addressing the cost of healthcare and creating transformative customer experiences with information, tools and services. Ultimately, we aim to create a brighter future for all of us. All we need are customer-centric leaders like you.
