Appeals Administrative Clerk

Appeals Administrative Clerk

Our mission is to enhance well-being by connecting individuals with vital health resources through a compassionate workforce that embodies the spirit of neighbors helping neighbors.

Our purpose is to care for people by connecting them to resources that help protect them in health related situations. To fulfill our purpose, we align our priorities to ensure each decision we make is ethical, empathetic, economical, and efficient. We care for people by being welcoming, authentic, truthful, consistent, and humble. We are continuously looking for ways to improve our process and how we get things done.

HealthOne seeks individuals with integrity and heart to embody our values. Whether you're starting your career or looking to develop additional skills to reach your full potential, HealthOne provides the means to help you achieve your goals.

Job Purpose : The Appeals Administrative Clerk supports the Appeals Department by performing essential administrative and data entry tasks to ensure timely and accurate processing of member appeals. This role helps maintain compliance and efficiency by entering appeals into Meditrac, uploading and organizing supporting documents, and monitoring appeals through resolution.

Essential Job Duties :

• Enter appeal cases accurately into Meditrac and update records as needed
• Upload and attach supporting documentation to appeal files to ensure completeness
• Track appeal cases from receipt through resolution, maintaining logs and status reports
• Communicate with internal departments to obtain missing information or documentation
• Assist in preparing correspondence and materials related to appeals processing
• Ensure compliance with organizational policies, procedures, and regulatory requirements in all appeal entries and documentation
• Provide general administrative support to the Appeals team including filing, scanning, and record keeping
• Assist with reporting on appeals volumes, turnaround times, and other performance metrics
• Support continuous improvement by identifying process efficiencies and sharing feedback with management
• Maintains regular and predictable attendance
• Consistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practice
• Works to encourage and promote company culture throughout the organization
• Other duties as may be assigned

Qualifications :

Physical Requirements : Prolonged periods of sitting at a desk and working on a computer. Moderate to significant amount of stress in meeting deadlines and dealing with day-to-day responsibilities. Must be able to drive a vehicle and daytime / overnight travel as required.

Benefits :

Pre-Employment Screening : Drug Screen and Background Check Required

HealthOne is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, disability, sex, age, ethnic or national origin, marital status, sexual orientation, gender identity or presentation, pregnancy, genetics, veteran status, or any other status protected by state or federal law.