A&G Non Clinical Specialist - Healthfirst
Remote, SC
About the Job
This position is Remote
Duties and Responsibilities
+ Responsible for case development and resolution of non-clinical cases, such as: certain types of claim denials, member complaints, and member and provider appeals. The end-to-end process requires the Specialist to independently:
+ Research issues
+ Reference and understand HFs internal health plans policies and procedures to frame decisions
+ Interpret regulations
+ Resolve cases and make critical decisions
+ Edit and finalize resolution letters
+ Manage all duties within regulatory timeframes
+ Communicate effectively to hand-off or pick-up work from colleagues
+ Work within a framework that measures productivity and quality for each Specialist against expectations
+ Additional duties as assigned
Minimum Qualifications
+ Bachelors degree from an accredited institution or relevant work experience
Preferred Qualifications**
+ Minimum of two (2) years of work experience in Managed Care or Health Insurance
+ Work experience in claims, customer service, home health, hospital or doctors office preferred
+ Experience working in care management systems, such as CCMS, TruCare or Hyland
+ Demonstrated critical thinking and decision-making competencies
+ Highly effective communication, organizational, and customer service skills
+ Demonstrated ability to be detail oriented, work under pressure, manage tight timeframes
Hiring Range*:
+ Greater New York City Area (NY, NJ, CT residents): $57,408 - $76,960
+ All Other Locations (within approved locations): $49,795 - $72,800
As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.
In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
_*The hiring range is defined as the lowest and highest salaries that Healthfirst in good faith would pay to a new hire, or for a job promotion, or transfer into this role._
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
Duties and Responsibilities
+ Responsible for case development and resolution of non-clinical cases, such as: certain types of claim denials, member complaints, and member and provider appeals. The end-to-end process requires the Specialist to independently:
+ Research issues
+ Reference and understand HFs internal health plans policies and procedures to frame decisions
+ Interpret regulations
+ Resolve cases and make critical decisions
+ Edit and finalize resolution letters
+ Manage all duties within regulatory timeframes
+ Communicate effectively to hand-off or pick-up work from colleagues
+ Work within a framework that measures productivity and quality for each Specialist against expectations
+ Additional duties as assigned
Minimum Qualifications
+ Bachelors degree from an accredited institution or relevant work experience
Preferred Qualifications**
+ Minimum of two (2) years of work experience in Managed Care or Health Insurance
+ Work experience in claims, customer service, home health, hospital or doctors office preferred
+ Experience working in care management systems, such as CCMS, TruCare or Hyland
+ Demonstrated critical thinking and decision-making competencies
+ Highly effective communication, organizational, and customer service skills
+ Demonstrated ability to be detail oriented, work under pressure, manage tight timeframes
Hiring Range*:
+ Greater New York City Area (NY, NJ, CT residents): $57,408 - $76,960
+ All Other Locations (within approved locations): $49,795 - $72,800
As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.
In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
_*The hiring range is defined as the lowest and highest salaries that Healthfirst in good faith would pay to a new hire, or for a job promotion, or transfer into this role._
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
Source : Healthfirst