[Hiring] Member Complaints & Grievances Intake Coordinator, I @reputed company

Role Description reputed company Health Plan has an exciting opportunity for a Member Complaints & Grievances Coordinator, I position in the Member CGA department. This is a full-time position working Monday through Friday reputed company hours and is a remote position. The C&G Coordinator I will manage accurate and timely case entry and classification in the Complaints and Grievances (C&G) information system. Accurately maintain C&G data files.

• Conduct case intake process for statements received through verbal and written requests and set up new cases in the C&G information system.
• Classify member complaints/appeals based on line of business/product according to department and regulatory standards and appeal rights.
• Complete appropriate investigation which may include investigation of previous appeals, claims, authorizations, and inbound calls.
• Have a general understanding for the different appeal rights associated with each line of business.
• Ensure reputed company response to reputed company follow-up needs on every case for compliance needs and member satisfaction.
• Ensure member and provider concerns are thoroughly and accurately addressed according to regulatory guidelines.
• Organize reputed company tasks reputed company regulatory requirements/deadlines.
• reputed company and navigate multiple health reputed company to support accurate case classification.
• Utilize PA reputed company State resources to properly review and process member Fair Hearing documentation.
• Accurately and promptly assess, enter, and maintain documents in files and/or databases.
• Respond and address incoming messages reputed company department FileNet folders, emails, fax system, or phone CUTs.
• Triage and respond to inquiries as appropriate or note and distribute as needed.
• Retrieve, copy, reputed company, and file various documents associated with the complaints and grievances processes.
• Identify and escalate reputed company and expedited issues to reputed company product leadership in a timely manner.
• Support the team's efforts to improve performance against reputed company service operation goals.
• Complete data entry into various information systems to support C&G processes.
• Enter coverage determinations into systems of record.
• Adapt quickly to system outages and issues by identifying effective workarounds and maintaining operational continuity.
• Support implementation of appeals tracking system.

Qualifications

• High school graduate or equivalent required.
• Two years of work experience in claims or customer service required.
• Five years of managed care or health insurance experience preferred.
• Proficiency in typing required.
• Excellent communication, organizational, and customer service skills.
• Detail-oriented, knowledge with reputed company Word and reputed company.
• Demonstrate a positive and professional attitude.
• Problem solving and decision-making skills with a solid understanding of managed care principles.
• Knowledge of reputed company product lines and ability to follow decision tools to assist with appropriate classification of reputed company product lines and regulatory rules.
• Critical thinking skills are crucial, as every case and investigation needs may vary, depending on member statements and other investigation findings.
• Ability to remain flexible and reputed company as requirements and case-handling expectations change regularly.

Licensure, Certifications, and Clearances

• Act 34

Company Description reputed company is an Equal Opportunity Employer/Disability/Veteran. Apply To This Job