The Appeals Research Associate is responsible for facilitating the resolution of administrative eligibility appeals, and appeals of the Massachusetts Healthcare Tax Penalty. The role includes responsibility for carrying out the informal dispute resolution process mandated by the Affordable Care Act. The candidate needs to possess well developed outreach and organizational skills and the ability to accurately complete special assignments in a timely manner.
The Appeals Research Associate will be responsible for:
- Examining received appellant appeals documentation
- Researching needed information in multiple systems to retrieve and validate data
- Reviewing and resolving appeal issues in compliance with timeframe mandated by regulations
- Communicating by telephone and in writing with appellants, their representatives, hearing officers, Connector Operations, Mass Health, the Department of Revenue and individuals to informally resolve appeals
- Scheduling hearings with hearing officers and issuing hearing notices to appellants
- Preparing documentation and supporting hearing officers on the day of hearings
- Proofreading hearing officer decisions prior to issuing determinations to appellants
- Providing case management to ensure appeal status is documented and case files are complete and up to date
- Identifying recurring appeal issues to flag for review by Connector Operations
- Assisting co-workers with administrative tasks as needed
- BA preferred.
- Experience in healthcare, commercial insurance, administrative law, databases, conflict resolution, customer service or call center, Medicaid or advocacy work are helpful.
- Ability to effectively manage workload and adjust to changing priorities.
- Excellent customer service skills including the ability to ask appropriate questions and actively listen to identify underlying questions and issues (root cause analysis).
- Solid research skills and experience maneuvering through multiple systems to access files to retrieve and validate data.
- Proficiency in Microsoft Office.
- A strong commitment to team work and a team environment.
- Bilingual Spanish/English abilities are beneficial but not required.
- This position requires the employee to work on-site in a closed office setting
- Employee may be requested to work an extended day and weekends to meet deadlines
Salary: Salary range is competitive; salary will be commensurate with experience.
If interested: Send cover letter and résumé to Connectoremail@example.com.
Please note: Due to the requirement of 268A, please complete the Applicant Disclosure Form and return with your application.
About the Health Connector:
The Commonwealth Health Insurance Connector Authority (Health Connector) is an independent public authority serving as the Affordable Care Act (ACA)-compliant marketplace for the Commonwealth. The organization is charged with providing subsidized and unsubsidized health insurance to individuals and small employers. The Health Connector also oversees policy development related to health care reform under both state and federal laws, as well as conducting public education and outreach about health care reform and coverage opportunities.
The Health Connector is an equal opportunity employer that values diversity as a vital characteristic of its work force. We consider qualified applicants without regard to race, color, religion, gender, sexual identity, gender identity, national origin or disability.