Job Details

ID #3340101
State Texas
City Bedford
Full-time
Salary USD TBD TBD
Source Cigna
Showed 2020-02-04
Date 2020-02-04
Deadline 2020-04-04
Category Et cetera
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Appeals Associate

Texas, Bedford 00000 Bedford USA

Vacancy expired!

Responsible for handling member and provider appeals/complaints involving medical necessity, retroactive authorizations, prescription drug coverage, and/or member eligibility. Responsible for tracking and reporting performance against HHSC guidelines. May complete intake, initialize the case for processing, and ensure cases are completed in a quality, organized, and timely fashion.Essential Duties and Responsibilities:

Responsible for intake of appeals/complaint unit mail, sorting, and distributing within required timeframes.

Responsible for date stamping and properly identifying request type and region. Utilizes appropriate system to research required documentation for case work up.

Responsible for determining the appropriate type of response to a requested appeal or complaint.

Must determine deadline dates on all cases and ensure they are met or exceeded.

Contacts parties to obtain missing/outstanding information for processing and completion.

Prepares all correspondence to gather and investigate a case.

Obtains waivers of liability (WOL), authorization of representative (AOR), and medical records requests.

Refers cases to other departments to gather information to complete the investigation.

Maintains tracking and monitoring information on a database and software used in the department.

Provides tracking and trending reports to departmental leadership on the root causes of appeals and complaints and the high volume appellants.

Responds to Expedited and Provider Claim appeals.

Keeps current with all requirements of STAR+PLUS plan appeals and complaints.

Provides training to peers as necessary in case handling.

Enters all job related activities in the applicable database.

Knowledge, Skills, Abilities Required:

Comprehensive knowledge in STAR+PLUS Appeals and Complaints and experience in managed care.

Strong analytical skills, ability to formulate, write reports and professional correspondence.

Knowledge of regulations and statutory language and interpretation.

Understanding of the claims, membership and health services systems.

Strong sense of customer service.

Exceptional written communication skills.

Strong interpersonal skills including tact, diplomacy, and flexibility to work effectively with senior administration, staff and general public.

High School Diploma or equivalent required.

Knowledge and Proficiency with Microsoft Office.

Strong data entry skills.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.If you require an accommodation based on your physical or mental disability please email: SeeYourself@cigna.com. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

Vacancy expired!

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