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Appeals Specialist at Kaiser Permanente

Posted in Customer Service 30+ days ago.

Type: Full-time
Location: Seattle, Washington





Job Description:

Triage and document requests for member appeals, OIC complaints, received via phone, fax, email and mail. Research for cases may involve: medical coverage, claims, authorizations, clinical review, eligibility, and interpretation of legal documents. Provide guidance about appeal process and requirements to members, prospective members, providers, other insurance carriers, agents, brokers, attorneys, employer groups and other member representatives over the telephone or via secure email. Answer high volume of complex verbal communication with members and providers interpreting needs in order to assure a clear and accurate assessment of their issue and assist them in a culturally appropriate manner. Prepare all material for case review in a way that meets regulatory requirements and the needs of the Appeal Coordinator who will investigate and/or consult on the case. Provide ongoing support to Appeal Coordinator.
Education Minimum Education Requirements Some College Communications or Healthcare Preferred Education Vocational School/Certificate Prog Healthcare to include medical terminology, coding, and HIPPA Knowledge/Skills Minimum Knowledge/Skills Requirements Document handling and data entry; Keyboarding skills while on phone. Microsoft Office products- Word & Excel; Adobe; Organization and prioritizing skills Attention to detail Customer service and communication skills on the phone. Can de-escalate difficult calls Able to clearly translate to documentation what caller is requesting Able to clearly respond in culturally appropriate manner Preferred Knowledge/Skills Proficiency with software used by the department. IBM Premier system Lotus Notes Internet and Intranet research Organization and prioritizing skills Attention to detail Customer service and communication skills on the phone. Can de-escalate difficult calls Able to clearly translate to documentation what caller is requesting Able to clearly respond in culturally appropriate manner Experience Minimum Experience Requirements 3 years Customer service on the phone 2 years Working in a medical setting. Preferred Experience 3 years Customer service at Group Health 3 years Working in a medical setting related to billing and/or insurance License/Certifications Minimum License/Certifications Requirements None Required Preferred License/Certifications None Required Kaiser Permanente is an Equal Opportunity Employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status, marital status, age, sexual orientation, gender identity or expression, or any other legally protected status.