A&G Non-Clinical Specialist
| Company | Healthfirst |
|---|---|
| Location | Lake Mary, FL, USA, New York, NY, USA |
| Salary | $49795 – $76960 |
| Type | Full-Time |
| Degrees | Bachelor’s |
| Experience Level | Junior, Mid Level |
Requirements
- Bachelor’s degree from an accredited institution or relevant work experience
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.
- Research issues
- Reference and understand HF’s 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
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 doctor’s 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