Appeal & Inquiry Advocate
Hybrid · Des Moines, Iowa, United States
Job Summary
Appeal & Inquiry Advocate responsible for reviewing, researching, and responding to formal written pre- and post-service appeals across multiple company areas. Provide accurate, timely, customized, and professional responses to customers; educate and advocate for Wellmark customers based on appeal situations; leverage broad knowledge of Wellmark's ecosystem to ensure thorough research and clear outcomes. Role emphasizes independent analysis, clear written explanations, and collaboration with stakeholders to support appeal decision outcomes.
Required Qualifications
- High School Diploma or GED
- 3+ years of insurance or related industry experience in appeals or research-focused roles
- Demonstrated strong written and verbal communication skills with ability to independently create explanatory and educational content
- Strong independent organizational, decision-making, and time management skills with attention to detail
- Ability to identify and approach complex problems from different angles and apply technical knowledge to policies/procedures
- Ability to identify issues or inconsistencies; obtain relevant information, relate and compare data from different sources and identify alternative solutions
- Demonstrated interpersonal skills with ability to build and maintain collaborative relationships
- Proven experience in Microsoft Office Suite and navigating internal systems
- Health Insurance experience preferred (knowledge of benefits, eligibility, claims, pricing, payment integrity, medical coding, and ability to read insurance regulations)
- Prior paralegal experience preferred
- Responsibilities include investigating, analyzing, and resolving complex pre- and post-service appeals across multiple company areas; responding in writing within regulatory timeframes; preparing files for medical review; collaborating with partner Blue Plans; outbound calls to providers; documenting all appeals and complaints; communicating remediation needs; tracking compliance issues; conducting root cause analysis and recommending process improvements; delivering presentations to stakeholders; supporting applications and systems and defining business requirements; cross-functional collaboration with senior team members; meeting performance standards and other duties as assigned
- an Equal Opportunity Employer
Additional Requirements
- Not sponsoring immigration/work visas (no H-1B, F-1 OPT/CPT, TN, L-1, J-1, etc.) currently or in the future to work in the United States
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