Junior Appeals Specialist

Summary:

The incumbent in this position is responsible for the timely review of all Appeals and Department of Insurance (DOI) Complaints for all product lines administered by CHP. The primary focus will be to review appeals submitted to determine if documentation received is an appeal or inquiry. Must possess good written communication skills; be a detail oriented problem solver with good time management skills.    

Qualifications and Abilities:
  • Experience administering and understanding health insurance.
  • Associate’s Degree and two years related on the job experience. An alternative would be a minimum of four years related job experience.
  • Detail oriented with strong communication skills.
  • Strong organizational skills, including thorough and complete follow-up to all time-sensitive items.
  • Excellent written and verbal communication skills.
  • Excellent interpersonal skills. Commitment to a team-oriented office environment.
  • Internet savvy and proficient with Microsoft Word, Outlook, and Excel. 
  • Understanding of the different state regulations.

Essential Functions and Job Responsibilities:

1.)    Perform detailed analysis of Appeals to determine if true appeal or inquiry;

2.)    Respond to acknowledgement of Appeals and DOI complaints within state/federal required timeframes;

3.)    Work with Compliance Department to maintain updated and accurate state/federal regulations and mandates;

4.)    Following up on inquiries and task assignments to various departments to completion;

5.)    Logging documentation into the Appeal Logs;

6.)    Maintaining detailed knowledge of new and existing products by closely working with colleagues;

7.)    Gathering documentation needed to respond to complaints;

8.)    Ability to multitask;

9.)    Ability to meet deadlines;

10.) Has a strong understanding of COB, ACA, HIPAA Privacy, an understanding of benefits and claims payment;

11.) Understanding of LuminX, Spartacus, and basic Microsoft Office skills;

12.) Other duties as assigned

Reports to Supervisor of Insurance Administration

If you meet the above qualifications and have an interest in this position, please send your resume and completed application to:

Mail: Consolidated Health Plans, Human Resources, 2077 Roosevelt Avenue, Springfield, MA 01104-3503

Fax: (413) 452-5329 Attn. Human Resources

Email: human_resources@consolidatedhealthplan.com

Phone: (413) 733-4540 ext. 120

 

 


Download Employment Application 

 

For more information contact us at human_resources@consolidatedhealthplan.com or call us at (413) 733-4540 ext. 120