Position Overview: Coordinate the internal appeals and grievances process by supporting entry of requests in timely manner to internal decision makers. Provide supporting compliance interpretation. Conduct in-depth research of regulatory, legal, contractual, and root cause of case specifics. Support member and provider experience.
Work Experience: Mimimum of two years customer service, claims processing or health insurance industry experience required. 1+ year of technical writing and conflict resolution experience preferred.
Education, Certificates, Licenses: High School Diploma required; Bachelor’s degree or equivalent experience preferred.
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.
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.
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.
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, age.