Manages a caseload of consumer behavioral healthcare insurance complaints concerning coverage and/or payment; Reviews and assesses medical records including psychological assessment and treatment plans, concerning but not limited to mental, emotional, behavioral and addictive disorders to determine appropriate treatment plans and eligibility for insurance benefit payment; Participates in insurance appeal hearings and serves as clinical expert to defend and demonstrate that the diagnostic assessment and treatment plans are appropriate and required to address client behavioral healthcare needs; Performs related duties as required. social work methodology, casework, group work and community mobilization; family and interpersonal relationship dynamics; values, sanctions, purposes and ethics of professional social work; social, cultural, economic, medical, psychological and legal issues which influence attitudes and behaviors of clients and families; mental illnesses and approaches to treatment; Considerable.