Operations Representative

3 weeks ago


El Dorado Hills CA, United States Blue Shield of California Full time

The Appeals and Grievances team receives, documents, investigates, refers, and coordinates grievances, appeals and complaints. In this role you will be responsible for taking incoming telephone calls, reviewing, researching, and responding to incoming appeals and grievances within established compliance timeframes.
 
Answer telephone inquiries regarding member appeals.
Research, review and resolve high level/high priority member grievances, appeals and complaints, while clarifying issues and educating customers in the process.
Interpret and explain health plan benefits, policies, procedures and functions to members and providers. 
Requires at least 4 years combined operations experience such as I&B, Claims, Customer Services, Regulatory Affairs; Requires knowledge of Microsoft Systems such as Power Point, Excel, and Word
Note: You may be placed in a specialty client, or other unit, such as CalPERs.
 



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