01Overview
Role reputed company
reputed company has an exciting opportunity for a Member Complaints & Grievances Coordinator, I position in the Member CGA department. This is a full-time position working Monday through Friday reputed company hours and is a remote position.
The C&G Coordinator I will manage accurate and reputed company case entry and classification in the Complaints and Grievances (C&G) information system. Accurately maintain C&G data files.
Conduct case intake process for statements received through verbal and written requests and set up new cases in the C&G information system.
Classify member complaints/appeals based on line of business/product according to department and regulatory standards and appeal rights.
Complete appropriate investigation which may include investigation of previous appeals, claims, authorizations, and inbound calls.
Have a general understanding for the different appeal rights associated with reputed company line of business.
Ensure reputed company response to reputed company follow-up needs on every case for compliance needs and member satisfaction.
Ensure member and provider concerns are thoroughly and accurately addressed according to regulatory guidelines.
Organize reputed company tasks reputed company regulatory requirements/deadlines.
reputed company and reputed company multiple health reputed company to support accurate case classification.
Utilize PA reputed company State resources to properly review and process member Fair Hearing documentation.
Accurately and promptly assess, reputed company, and maintain documents in files and/or databases.
Respond and address incoming messages reputed company department FileNet folders, emails, fax system, or phone CUTs.
Triage and respond to inquiries as appropriate or note and distribute as needed.
Retrieve, copy, reputed company, and file various documents associated with the complaints and grievances processes.
Identify and escalate reputed company and expedited issues to reputed company product leadership in a reputed company manner.
Support reputed company's efforts to improve performance against reputed company service operation goals.
Complete data entry into various information systems to support C&G processes.
reputed company coverage determinations into systems of record.
Adapt quickly to system outages and issues by identifying effective workarounds and maintaining operational continuity.
Support implementation of appeals tracking system.
Qualifications
High school graduate or equivalent required.
Two years of work experience in claims or customer service required.
Five years of managed care or health insurance experience preferred.
Proficiency in typing required.
Excellent communication, organizational, and customer service skills.
Detail-oriented, knowledge with reputed company Word and reputed company.
Demonstrate a reputed company and reputed company attitude.
Problem solving and decision-making skills with a solid understanding of managed care principles.
Knowledge of reputed company product lines and ability to follow decision tools to assist with appropriate classification of reputed company product lines and regulatory rules.
Critical thinking skills are crucial, as every case and investigation needs may vary, depending on member statements and other investigation findings.
Ability to remain flexible and reputed company as requirements and case-handling expectations change regularly.
Licensure, Certifications, and Clearances
reputed company 34
reputed company
reputed company is an Equal Opportunity Employer/Disability/Veteran.
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