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Support Specialist II - Member Advocacy and Appeals
Job Reference #: 5000428330806
Categories: IT - Computer Services & Support
Exempt or Non-ExemptNon-exempt
Provides high level administrative and clerical support to Member Advocacy and Appeals department.
- Associate's degree and two years related experience or equivalent combination of education and experience.
- Working knowledge of basic office equipment and MS Office applications.
- Strong verbal and written communication skills.
Duties and Responsibilities
- Handles the intake, closing and reporting processes for all Department cases that involve complex confidential issues in a highly time sensitive environment. This includes the intake of member and provider calls, correspondence and internal referrals; evaluation of information to determine best course of action; and follow-up with Department staff and internal departments to ensure claims processing and benefit payments are completed consistent with information relayed to members/providers and within timeframe required by law, regulation, policy or other requirement. With guidance from Supervisor, 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 the member as well as minimize the number of cases escalated to Case Resolution Specialists.
- Creates and maintains electronic files and hard copy paper files; maintains and tracks department cases and files; prepares and issues reports required for various internal committee meetings and as needed on an ad hoc basis. Identifies potential issues when preparing and reviewing reports and discusses these with the department supervisor or coordinator. Updates database for all MAA cases.
- Prepares materials for reviews (make copies, create case binders, coordinate mailing or electronic communications, etc.) and ensures proper distribution to reviewers (particularly for Administrative Review Panel and Appeals Committee). This includes ensuring all materials meet minimum necessary rule requirements consistent with internal policies and state/federal privacy laws.
- Coordinates all meetings including all Appeals Committee and Administrative Review Panel meetings.
- Performs other duties as assigned.