Job Description

MISSION


Our mission is to enhance well-being by connecting individuals with vital health resources through a compassionate workforce that embodies the spirit of neighbors helping neighbors.


VALUES


HealthOne is guided by a cultural framework that embodies our values and drives our decisions.


Our PURPOSE is to care for people by connecting them to resources that help protect them in health related situations. To fulfill our purpose, we align our PRIORITIES to ensure each decision we make is ethical, empathetic, economical, and efficient. We care for PEOPLE by being welcoming, authentic, truthful, consistent, and humble. We are continuously looking for ways to improve our PROCESS and how we get things done.


HealthOne seeks individuals with integrity and heart to embody our values. Whether you're starting your career or looking to develop additional skills to reach your full potential, HealthOne provides the means to help you achieve your goals.


JOB PURPOSE


The Appeals Administrative Clerk supports the Appeals Department by performing essential administrative and data entry tasks to ensure timely and accurate processing of member appeals. This role helps maintain compliance and efficiency by entering appeals into Meditrac, uploading and organizing supporting documents, and monitoring appeals through resolution.


ESSENTIAL JOB DUTIES


Enter appeal cases accurately into Meditrac and update records as needed Upload and attach supporting documentation to appeal files to ensure completeness Track appeal cases from receipt through resolution, maintaining logs and status reports Communicate with internal departments to obtain missing information or documentation Assist in preparing correspondence and materials related to appeals processing Ensure compliance with organizational policies, procedures, and regulatory requirements in all appeal entries and documentation Provide general administrative support to the Appeals team including filing, scanning, and record keeping Assist with reporting on appeals volumes, turnaround times, and other performance metrics Support continuous improvement by identifying process efficiencies and sharing feedback with management Maintains regular and predictable attendance Consistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practice Works to encourage and promote Company culture throughout the organization Other duties as may be assigned QUALIFICATIONS


High school diploma or equivalent required; associate's degree preferred 1-2 years of administrative, clerical, or data entry experience in a healthcare, insurance, or related setting preferred Experience with appeals, grievances, or utilization management processes a plus Proficiency with Microsoft Office Suite (Word, Excel, Outlook) and ability to learn new systems quickly Familiarity with Meditrac or similar case management/document management systems preferred Strong attention to detail and accuracy in data entry and documentation Excellent organizational skills with the ability to manage multiple tasks and meet deadlines Effective written and verbal communication skills for internal correspondence and documentation Ability to work independently as well as collaboratively in a team environment Commitment to maintaining confidentiality and compliance with HIPAA and company policies

PHYSICAL REQUIREMENTS


Prolonged periods of sitting at a desk and working on a computer. Moderate to significant amount of stress in meeting deadlines and dealing with day-to-day responsibilities. Must be able to drive a vehicle and daytime/overnight travel as required.





BENEFITS


401K (4% Match, Immediate Vesting)


Accident insurance


Competitive salary


Critical Illness Insurance


Dental Insurance


Employee Assistance Program


Flexible Spending Account


Health & Wellness Program


Health Savings Account


Life & AD&D Insurance


Long Term Disability


Medical Insurance


Paid Time Off


Pet Insurance


Short Term Disability


Vision Insurance


PRE-EMPLOYMENT SCREENING


Drug Screen and Background Check Required


HEALTHONE IS AN EQUAL OPPORTUNITY EMPLOYER


All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, disability, sex, age, ethnic or national origin, marital status, sexual orientation, gender identity or presentation, pregnancy, genetics, veteran status, or any other status protected by state or federal law.