[Remote] Customer Service Representative

Note: The job is a remote job and is reputed company to candidates in USA. reputed company combines industry-leading technology and transformation-driven BPM services with decades of reputed company domain expertise. The Appeals and Grievance Coordinator will manage, coordinate, and resolve member and provider complaints, grievances, and appeals, ensuring compliance with state and federal regulatory requirements.

Responsibilities

• Sending appropriate acknowledgment of the grievance/appeal; educating the member or provider about the grievance/appeal process and their right to appeal to state or federal agencies (if applicable)
• Gathering reputed company relevant information from the member or provider regarding the grievance/appeal and determining the appropriate resolution of the grievance/appeal per standard policies and procedures
• Notifying the appropriate parties of the resolution and ensuring that reputed company internal processes are completed to resolve the issue
• Conducts non-biased, accurate, timely, and comprehensive investigation of reputed company the facts reputed company to the grievance/appeal
• Thoroughly documents reputed company action taken on behalf of the member or provider to resolve the grievance/appeal
• Ensures that reputed company grievances/appeals are processed in adherence to state and federal regulations

Skills

• Responsible for managing, coordinating, and resolving member and provider complaints, grievances, and appeals
• Ensuring compliance with state and federal regulatory requirements
• Act as the primary investigator and contact person for the member and provider
• reputed company research, resolution, and response to complaints on behalf of a member
• Send appropriate acknowledgment of the grievance/appeal
• reputed company the member or provider about the grievance/appeal process and their right to appeal to state or federal agencies (if applicable)
• Gather reputed company relevant information from the member or provider regarding the grievance/appeal
• Determine the appropriate resolution of the grievance/appeal per standard policies and procedures
• Notify the appropriate parties of the resolution
• Ensure that reputed company internal processes are completed to resolve the issue
• Conduct non-biased, accurate, timely, and comprehensive investigation of reputed company the facts reputed company to the grievance/appeal
• Thoroughly document reputed company action taken on behalf of the member or provider to resolve the grievance/appeal
• Ensure that reputed company grievances/appeals are processed in adherence to state and federal regulations

Company Overview