Appeal Resolution Supervisor jobs in South Carolina

Company :

Job Description :

JOB SUMMARY

This job is responsible for problem ticket resolution. Requires a beginning knowledge base across the functional areas and specific expertise on multiple applications/platforms. Expeditiously and accurately performs deep dive issue analysis and problem ticket review, assessing information/details for updates to determine potential end impacts, and corrections, as needed. May transfer the ticket to the appropriate area if further action is needed for resolution (i.e., coding changes).

ESSENTIAL RESPONSIBILITIES

• Solve system problems with available technology including hardware, software, databases, and peripherals. Create and run queries using SQL and utilize apps to review files.
• Review various reports (for example, fallout reports) to identify and correct system issues pro-activley/pre-emptively. If issues are identified, will work to correct to ensure there are no negative down stream impacts.
• Research and analyze system needs, system development, system process analysis, design, and re-engineering. Recommend changes (in processes, design, etc.) when warranted.
• If problem resolution impacts external vendors, act as key contact with vendors to resolve issues as needed.
• May participate in cross-functional process improvement efforts to address trends identified in ticket resolution. This may include gathering requirements, creating business cases, and creating/executing test cases.
• Other duties as assigned or requested.

EDUCATION

Required

• Bachelor's Degree in Business Administration/Management, Information Technology or Information Systems

Substitutions

• 6 years of relevant, progressive experience in lieu of degree

Preferred

• None

EXPERIENCE

Required

• 0 - 3 years in IS/IT

Preferred

• 0 - 1 year in the Healthcare or Health Insurance Industry

LICENSES AND CERTIFICATIONS

Required

• None

Preferred

• Information Technology Infrastructure Library (ITIL)

SKILLS

• Communication Skills
• Analytical Skills
• Research Skills
• Data Analysis
• Customer Service
• Collaborative problem solving

Language (Other than English)

None

Travel Required

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-Based

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Never

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

Pay Range Maximum:

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

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