Appeals Intake Specialist

Job Description

• Process a variety of requests, inquiries and transactions via phone, email, fax, and mail

• Review requests to ensure accuracy

• Support internal & external customers via phone or email

• Document all pertinent information related to the call/inquiry, attach supporting information as applicable and if unable to resolve route to appropriate area for follow up as applicable

• Gather and analyze data to provide feedback to Team Leads on employee development needs and/or specific providers requiring education on prior approval or pre-certification process 

• Screen inquiries to determine if authorization is required

• Verify member benefits and eligibility and/or provider setup.

• Maintain and update Service Requests and research incorrect or missing information.

• Triage and assign all incoming inquiries in a timely, efficient manner throughout the day to appropriate staff

• Perform Peer Audits monthly as required

• Provide clinical review outcome notification to members and providers (verbal and written)

Hiring Requirements

• High school diploma or GED

• 3+ years of experience in related field.

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets,  licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. 

*Based on annual corporate goal achievement and individual performance.  

Skills

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