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Appeals and Grievance Support at PacificSource

Posted in Other 30+ days ago.

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Location: Boise, Idaho

Job Description:
Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care!

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

Position Overview: Provide clerical assistance to Appeals and Grievance team in entry and maintenance of case records. Provide high quality customer service to internal and external customers regarding appeals and grievance inquiries. Support member and ensure customer satisfaction.

Essential Responsibilities:
  • Process intake of appeals and grievances into the departments tracking database.
  • Monitor incoming documents via fax, web, email, USPS and route to appropriate entity in a timely manner and in accordance with department processes.
  • Maintain office supply inventory for the department.
  • Communicate complex information related to A&G rules and regulations, verbally and in writing, to internal and external customers.
  • Effectively capture and transcribe meeting minutes.
  • Work collaboratively in an objective, professional, diplomatic manner with all internal and external customers.

Supporting Responsibilities:
  • Provide clerical backup for other A&G staff as needed.
  • Meet department and company performance and attendance expectations.
  • Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
  • Perform other duties as assigned.

Work Experience: Minimum one year customer service, and/or claims processing, health insurance industry process experience required. Data entry experience preferred.

Education, Certificates, Licenses: High School Diploma required.

Knowledge: Requires strong research, analytical and data entry skills. Experience using Facets, Onbase, and other software packages used by PacificSource is strongly preferred. Must have basic math skills, the ability to work under strict deadlines, and excellent organizational skills.

  • Adaptability
  • Building Customer Loyalty
  • Building Strategic Work Relationships
  • Building Trust
  • Continuous Improvement
  • Work Standards
  • Contributing to Team Success
  • Planning and Organizing

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.

Our Values
  • We are committed to doing the right thing.
  • We are one team working toward a common goal.
  • We are each responsible for customer service.
  • We practice open communication at all levels of the company to foster individual, team and company growth.
  • We actively participate in efforts to improve our many communities-internally and externally.
  • We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.