Appeal Specialist II

5 days ago

Houston, Texas, United States Health Care Service Corporation Full time $50,000 - $70,000 per year

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job SummaryUnder Supervision, This Position Is Responsible For Processing And Adjudicating Complex Non-Utilization. Management Appeals According To The Appropriate Federal, State, And Ncqa Requirements And Regulations; And Responding, By Phone, In Person, Or In Writing, To All Inquiries Involving Member*S Requests For Appeals. May Train And Mentor Less Experienced Appeals Specialists.

****THIS IS NOT A FULLY REMOTE POSITION**** THIS ROLE IS HYBRID IN OUR HOUSTON,TX OFFICE LOCATED AT 8101 W SAM HOUSTON PARKWAY S.

****THE STARTING PAYRATE FOR THIS ROLE IS $22.50-$25.00/hr BASED UPON EXPERIENCE.****

JOB REQUIREMENTS:
* High School Degree or GED.
* 3 years' experience in a customer service role OR in a health insurance or medical environment.
* Knowledge of medical terminology to include coding.
* Experience and skills to analyze and assist customer based on knowledge of federal, state, and NCQA guidelines.
* Experience and skills to organize tasks and accommodate large volume of reference materials.
* Experience and skills to understand fine details of customer complaint issues.
* Verbal and written communication skills.

PREFERRED JOB REQUIREMENTS:
*Blue Chip claims payment experience.

*Medicare Advantage experience.

*Medical billing & Coding.
* 2-year experience processing claims and utilizing a claims payment system.
* Bilingual English/Spanish.

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process

Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees.  Learn more about our benefit offerings by visiting

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range$ $37.10

Exact compensation may vary based on skills, experience, and location.

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