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Case Specialist

unlimited holidays - extra holidays - extra parental leave - long remote period allowed
Remote: 
Full Remote
Contract: 
Full time
Experience: 
Entry-level / graduate
Work from: 
Texas (USA), United States

Offer summary

Qualifications:

High school diploma or equivalent, Previous clerical experience in managed care.

Key responsabilities:

  • Provide admin support for UM department
  • Handle denial, appeal, and complaint process, data reporting
  • Maintain filing system and answer incoming calls
Curative logo
Curative Scaleup https://curative.com/
201 - 500 Employees
About Curative
Curative (Curative Insurance Company) is a leading healthcare services company that has created and launched a first-of-its-kind employer-based health insurance plan. Founded by CEO Fred Turner in 2020, Curative is reengineering health insurance by providing unmatched simplicity and cost transparency with a competitive monthly premium and zero additional costs*. Curative is remaking our healthcare system into one that works for and supports members’ whole health and well-being through every step of their personal health journey. Previously, Curative and its managed medical entities were national leaders bringing COVID-19 testing and vaccine-administration resources to bear in response to the pandemic. For more information on Curative, visit www.curative.com, subscribe to our newsletter at curative.com/subscribe, or follow us on Facebook, Instagram, Twitter, or LinkedIn.*To qualify, members need to complete a Baseline Visit within 120 days of the plan's effective date, which kicks off support of the member’s well-being through every step of their health journey.**Please be aware of counterfeit/fake job postings and profiles using different aliases that fraudulently allege to be from Curative. All job postings and correspondence will be sourced via Curative Inc. We will never ask you for any sort of payment nor will we ever conduct interviews via text message. If you have received or suspect any similar activity attributed to Curative, please report it at www.ic3.gov and contact abuse@curative.com directly for further assistance.
See more Curative offers

Job description

Provides administrative support to the Utilization Management Department by

assisting with the denial, appeal and complaint process, handling reporting functions,

screen/assist with incoming calls and assisting the Utilization Management staff as needed to

increase departmental productivity. Carries out all duties while respecting member and provider

confidentiality and promoting the mission and philosophy of the organization supported.

Essential Functions

  • Types, mails, and logs denial and appeal and complaint letters.
  • Generates reporting data for the health plans regarding denials, appeals and complaints on a monthly basis.
  • Maintains filing system for denials, appeals and complaints.
  • Accepts incoming calls and screens or resolves calls in accordance with plan design and authorization requirements.
  • Enters authorizations for services as delegated by assignment.
  • Runs and distributes reports from VBA data bases including authorization letters, daily authorization reports sent to health plans, and monthly statistical reports for management.
  • Creates and designs forms and reports as needed.
  • Maintains UM Committee minutes and updates UM Policy & Procedures as needed.

Other Duties And Responsibilities

  • Assists supervisors with special projects as needed.
  • Performs other duties as assigned.
  • Maintains departmental data entry manual and edits content and updates format as needed.
  • Maintains files.
  • Provides desktop support to the department.

Minimum Qualifications

Education: High school diploma or equivalent.

Experience: Previous clerical experience, preferably in a managed care or medical

management environment.

Knowledge, Skills, And Abilities

  • Knowledge of or ability to learn Microsoft Access
  • Knowledge of or ability to learn medical terminology
  • Skill with operating PC and using word processing and spreadsheet software applications

Required profile

Experience

Level of experience: Entry-level / graduate
Spoken language(s):
English
Check out the description to know which languages are mandatory.

Hard Skills

Microsoft AccessMedical Terminology

Other Skills

  • Communication
  • Problem Solving
Are you interested?

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