Appeals Specialist II

Job ID: DLP-1020277 Description:

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants.We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can email us here to request reasonable accommodations.

Please note that only requests for accommodations in the application process will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "my account" and click on "View your job submissions".


Under supervision, this position is responsible for processing and adjudicating non-Utilization Management appeals according to the appropriate federal, state, and NCQA requirements and regulations; and responding, by phone, in person, or in writing, to all inquiries involving members requests for appeals.


  • High School Degree or GED.
  • 3 years experience in a customer service role in a health insurance or medical environment
  • 2 year experience processing claims and utilizing a claims payment system.
  • Knowledge of medical terminology to include coding.
  • Experience and skills to analyze claims processing issues and assist customer based on knowledge of federal, state, and NCQA guidelines.
  • Experience and skills to organize tasks and accommodate large volume of reference materials.
  • Experience and skills to understand fine details of customer complaint issues.
  • Verbal and written communication skills.


  • Blue Chip claims payment experience.
  • Bilingual English/Spanish.


  • CA
  • CB*

Requirements: Expertise Claims & Customer Service, Government Programs, Other Job Type Full-Time Regular Location NM - Albuquerque

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