Case Resolution Specialist II

1. Conducts critical analysis of highly complex and sensitive member and provider appeals, inquiries and grievances and applies internal policies and procedures, contractual provisions, and regulatory requirements.
   
   • Secures information from internal and external resources to resolve issues.
   • Functions as a liaison with providers, members and internal decision makers in representing HMSA objectives, goals, and expectations for meeting contractual, regulatory, and accreditation requirements.
   • Negotiates/resolves sensitive issues with internal and external parties.
   • Negotiates fees on behalf of members for non-covered or nonparticipating provider services in addition to soliciting claims and other related medical information from providers in order to resolve member inquiries.
   • Takes all facts and research from internal and external resources and presents a full explanation of the member's or provider's position and concerns to manageme...

Ready to Apply?

Submit your application today and join our talented team at HMSA.