Appeal & Inquiry Advocate

The Appeal & Inquiry Advocate role involves reviewing, researching, and responding to formal written pre- and post-service appeals, providing accurate, timely, and professional responses to customers. The role requires strong analytical skills, written and verbal communication skills, and the ability to independently create explanatory and educational content. The Advocate will work in a hybrid environment, leveraging broad knowledge of Wellmark's ecosystem to ensure thorough research and accurate outcomes, enhancing the customer experience.

What You Will Do

The main responsibilities of the Appeal & Inquiry Advocate include thoroughly investigating and analyzing complex pre- and post-service appeals, responding in writing to appeals or complaints within regulatory timeframes, preparing appeal files for medical review, and collaborating with partner Blue Plans to resolve inter-plan processing issues.

Why It Might Be a Fit

This role may be a great fit for someone who enjoys solving complex problems, takes pride in turning research into clear written communication, and thrives in an environment where every case is a puzzle and every outcome matters. The Advocate will have the opportunity to make a real impact and work in a collaborative environment with senior team members.

Requirements

• High School Diploma or GED
• 3+ years of insurance or related industry experience in appeals or research-focused roles
• Strong analytical skills
• Strong written and verbal communication skills
• Independent organizational, decision-making, and time management skills
• Ability to identify and approach complex problems from different angles
• Ability to identify issues or inconsistencies
• Proven experience in Microsoft Office Suite
• Health Insurance experience, including knowledge of benefits, eligibility, claims, pricing, payment integrity, medical coding, and ability to read and understand insurance regulations

Benefits

• Health insurance
• Other benefits not explicitly mentioned