Customer Service Advocate, Advanced Healthcare Specialist
7 days ago
Our team is responsible for resolving member appeals and grievances in a timely manner.
About the RoleThis role involves answering inquiries, investigating issues, and providing explanations of health plan benefits to members and providers.
You will be working with our Appeals and Grievances team to ensure that all cases are resolved within established compliance timeframes.
Key Responsibilities- Answering telephone inquiries regarding member appeals and grievances.
- Researching and resolving high-priority member grievances, appeals, and complaints.
- Preparing files for clinician review and administering ongoing grievance tracking, trending, and reporting.
- Working collaboratively with your team to meet compliance standards.
To succeed in this role, you will need:
- A high school diploma or equivalent.
- At least 4 years of combined operations experience, including I&B, Claims, Customer Services, or Regulatory Affairs.
- Knowledge of Microsoft Systems such as PowerPoint, Excel, and Word.
The estimated salary for this role is $25.49 - $35.11 per hour, based on location and experience.
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