What are the responsibilities and job description for the Member Advocacy & Appeals Support Specialist II position at HMSA?
Handles the intake processes for all Department cases that involve complex confidential issues in a highly time sensitive environment.
Intake of member and provider calls, faxes, email correspondence, and internal referrals; evaluation of information to determine best course of action; and follow-up with Department staff and internal departments to ensure accurate case creation are completed consistent with information relayed to members/providers and within timeframe required by law, regulation, policy, or other requirement.
Conduct analysis of sensitive member and provider appeals, inquiries and grievances and applies internal policies and procedures, contractual provisions, and regulatory requirements.
Triage cases to resolve them upon initial inquiry/intake to best service members and reduce cases escalated to Case Resolution Specialists.
Creates and maintains accurate electronic case files for appeals and grievances from members and providers within the scope of internal policies and procedures, and regulatory timeframe requirements.;.
Identifies potential issues when preparing and reviewing electronic cases including case file and program database entry and discusses these with the department supervisor or coordinator.
Updates electronic case folder and computer program database.
Handles internal and external customer service calls regarding member or provider appeals or grievance requests.
Is able to handle complex issues and requests by listening for understanding and communicates appropriately and professionally with internal/external customers.
Is able to identify what the caller is requesting, and asks questions for understanding, to offer excellent customer service experience.
Performs all other miscellaneous responsibilities and duties as assigned or directed.
Salary.com Estimation for Member Advocacy & Appeals Support Specialist II in Honolulu, HI
$42,355 to $50,885
If your compensation planning software is too rigid to deploy winning incentive strategies, it’s time to find an adaptable solution.
Compensation Planning
Enhance your organization's compensation strategy with salary data sets that HR and team managers can use to pay your staff right.
Surveys & Data Sets
What is the career path for a Member Advocacy & Appeals Support Specialist II?
Sign up to receive alerts about other jobs on the Member Advocacy & Appeals Support Specialist II career path by checking the boxes next to the positions that interest you.
Sign up to receive alerts about other jobs with skills like those required for the Member Advocacy & Appeals Support Specialist II.
Click the checkbox next to the jobs that you are interested in.
Reporting, Research & Analysis Analyzes and forecasts premium revenue, risk adjustment payments, and other revenue streams related to lines of business wit...more
Employment Type Full-time Exempt or Non-Exempt Exempt Job Summary **Hybrid Work Environment - Must reside on Oahu ** Pay Range: $59,000 - $116,000, positio...more
Employment Type Full-time Exempt or Non-Exempt Exempt Job Summary **Hybrid Work Environment - Must reside on Oahu ** Pay Range: $59,000 - $116,000, positio...more
Employment Type Full-time Exempt or Non-Exempt Exempt Job Summary Hybrid Work Environment - Must reside on Oahu ** Pay Range: $78,000 - $153,000, position ...more
Not the job you're looking for? Here are some other Member Advocacy & Appeals Support Specialist II jobs in the Honolulu, HI area that may be a better fit.
We don't have any other Member Advocacy & Appeals Support Specialist II jobs in the Honolulu, HI area right now.
Agil3 Technology Solutions (A3T) is seeking an experienced IT Support Specialist II to provide Tier I/Tier II technical, desktop, and end-user support for ...more
