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Medicare Advantage Grievance

2 months ago

Detroit, United States G-TECH Services Full time
Job DescriptionJob Description

Individuals will be responsible for analyzing, researching, resolving, and responding to complaints, appeals, and grievances from our clients members and regulatory agencies.

Responds to all cases require a detailed written correspondence to the inquirer. All response letters must include specific elements to meet regulatory and accreditation guidelines.

Please note that we are looking for individual who can work in a high stress, high volume, and heavily audited area. We anticipate this will be a long-term position. Extensive training provided

Candidates should have and exhibit the following skills and attributes:

  • Candidate should be analytical, having the ability to examine a matter, the facts, contextual information and make an informed decision or implement and execute a reasonable, rational resolution
  • Strong letter writing and proofreading skills
  • Excellent verbal and written communication skills
  • Must have a high attention to detail and remain organized
  • Ability to work in a fast-paced environment with tight deadlines and high quality standards
  • Ability to work well under stressful circumstances
  • Strong PC application and system skills- having the ability to navigate multiple computer systems and databases
  • Must have previous customer service experience

"Qualifications"
• High School Diploma or GED required. Associates will be considered a priority
• Two (2) years customer service experience required.
• Two (2) years health insurance experience and familiarity with health insurance state and federal regulations preferred.
• Strong analytical, critical thinking, organizational, time management and problem resolution skills.
• Excellent verbal and written communication skills.
• Strong PC applications (i.e. Microsoft Excel, Word, and Outlook).
• High regard for protecting confidentiality of corporate information.
• Proven ability to foster and maintain open, collaborative and constructive relationships within internal, external and leadership to achieve departmental and corporate results.
• Ability to apply policies and procedures to arrive at accurate conclusions.
• Ability to analyze, interpret, apply reason and logic, conduct research structure a clear and thorough response.
• Ability to quickly learn and navigate diverse products and information systems.
• An understanding of MA servicing structure related to grievance and appeals or experience in claims with the ability to apply EOC research in prepping cases preferred.
• Demonstrates one can handle multiple tasks/projects concurrently with minimal supervision

Medicare Advantage
1. Accountable for CMS Chapter 13, CMS Audit Compliance and Star Quality Measures:
2. Data entry accuracy is required.
 

Company DescriptionG-TECH Services, Inc. is a leading certified recruitment and placement firm that provides high-quality, flexible staffing solutions to a nationwide client base. We pride ourselves in keeping employee attrition low and offering exciting career opportunities to Engineers and IT professionals We are large enough to make a difference and small enough to genuinely care about each and every one of our employees
We work with the best of the best Join us todayCompany DescriptionG-TECH Services, Inc. is a leading certified recruitment and placement firm that provides high-quality, flexible staffing solutions to a nationwide client base. We pride ourselves in keeping employee attrition low and offering exciting career opportunities to Engineers and IT professionals We are large enough to make a difference and small enough to genuinely care about each and every one of our employees\r
We work with the best of the best Join us today