Member Appeals Team Associate

The Member Appeals team owns specialized processes that require close collaboration with finance, legal, product, and other internal teams. As a member of the Member Appeals team, you will be responsible for appeals and Independent Review Organizations (IRO) submissions & coordination. You will also be responsible for the development of policies & procedures that enable successful operations and ensure operational compliance on the Member Claims team as well as other teams within Customer Experience (CX).

What you'll do:

• Support the execution of the day-to-day operations of our medical appeals, including but not limited to:
  • Researching United States Preventive Services Task Force (USPSTF), National Comprehensive Cancer Network (NCCN), American Cancer Society (ACS) and (Health Resources and Services Administration (HRSA) recommendations
  • Submitting external review inquiries and processing their determinations
  • Coordinating with third parties such as IROs and medical network partners while reviewing appeals
  • Reviewing claim adjudication
  • Researching our plan stacks
  • Navigating client SPD’s
  • Writing member and provider facing appeal determinations using Microsoft Word and Adobe Acrobat
• Work cross-functionally on issues with Legal, Member Advocacy, Collective Care, and the Member Claims teams to delight our members
• Support quarterly team projects focused on process scalability, workflow improvements, and other operational improvements 
• Attend weekly office hours & team working sessions to collaborate on, discuss, and help resolve various issues that are escalated to our team as they arise

To be successful in this role, you'll need:

• To be self-motivated, intellectually curious, and take ownership for everything you do
• To pay extreme attention to detail
• To use good judgment and are comfortable when handling sensitive matters 
• To think critically and are willing to question the status quo in a constructive and thoughtful manner 
• To enjoy researching, discussing, and developing consistent policies and approaches to work, and are comfortable operating in ambiguous situations where there is no clear right answer 
• To have been, at a minimum, meeting all expectations in your current role at Collective Health
• To be a committed team player
• To thrive on change and are enthusiastic about being along for the ride and learning from our experiences together
• Excellent verbal, written and interpersonal communication skills
• To possess a passion for Collective Health’s mission to transform the health insurance experience for employers and their employees

Pay Transparency Statement 

This is a hybrid position based out of our Lehi office, with the expectation of being in office at least two weekdays per week. #LI-hybrid 

The actual pay rate offered within the range will depend on factors including geographic location, qualifications, experience, and internal equity. In addition to the hourly rate, you will be eligible for stock options and benefits like health insurance, 401k, and paid time off. Learn more about our benefits at https://jobs.collectivehealth.com/benefits/.