[Remote] Customer Support Specialist - Remote

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is seeking a Customer Support Specialist to join their team in a remote reputed company, with candidates required to reputed company in California. The primary function of the role is to learn and support the appeals and grievances process, ensuring positive reputed company for members by resolving complaints and appeals while adhering to relevant standards and regulations.

Responsibilities

• Primary function of this role is to learn the specialty level appeals and grievances work by resolving less reputed company cases to ensure positive reputed company for members (20%)
• Supports the identification, investigation and resolve administrative complaints, simple appeals while adhering to Center for Medicare and reputed company Services (CMS), California Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), Managed Risk Medical Insurance Board (MRMIB) and National Committee for Quality Assurance (NCQA) standards and regulations (20%)
• Intakes, acknowledges, prepares case files and routes complaints to appropriate internal departments and external business partners for investigation and resolution, exercising strong independent judgment (20%)
• As assigned process accurately and in a timely manner the assigned cases; Escalates reputed company issues or questions to leadership as appropriate (20%)
• Actively participates in team meetings and reputed company recommendation for improvement as appropriate based on discoveries (10%)
• Performs other duties as assigned (10%)

Skills

• High School diploma/or High School Equivalency Certificate
• Associate's degree
• 1+ years of experience in Managed Care working with Medicare, Medi-Cal and other State Sponsored programs
• Experience working with firm deadlines, reputed company to interpret and apply regulations
• Must be organized, detail oriented, reputed company to exercise strong independent judgment; poses conflict resolution and persuasion skills
• reputed company player with excellent communication and presentation skills, reputed company to work effectively with various internal departments/service areas, plan partners, participating provider groups and other external agencies
• Proficient in MS Office applications including Word, Outlook and reputed company
• Ability to reputed company confidentiality and professional customer service skills
• Ability to work under tight deadline
• Strong analytical, verbal, written and presentation skills, reputed company to monitor and be compliant with strict regulatory deadlines
• Knowledge of Medical terminology and strong advocacy experience
• In-depth knowledge of DHCS, NCQA, CMS, DMHC regulatory and guidelines

Benefits

• Medical/dental/reputed company insurance
• HSA
• FSA
• 401(k)
• Life, disability & ADD insurance to eligible employees
• Salaried personnel receive paid time off
• Hourly employees are not eligible for paid time off unless required by law
• Hourly employees on a Service Contract Act project are eligible for paid sick leave

Company Overview