Case Resolution Specialist - Medical Insurance $22/h WEEKLY PAY

Description

 Conducts critical analysis of highly complex and sensitive member and provider appeals, inquiries and grievances and applies internal policies and procedures, contractual provisions, and regulatory requirements.

 Takes all facts and research from internal and external resources and presents a full explanation of the member's or provider's position and concerns to management and decision makers.

 Assists Supervisor and Coordinator in working as a liaison with providers, members and internal decision makers in representing HMSA objectives, goals, and expectations for meeting contractual, regulatory, and accreditation requirements.

 Identifies member problems, member education needs, or trends and report these to manager, as well as recommend resolution. Takes a proactive role in reviewing, digesting and communicating any new regulation, standard, business change, etc. affecting the member advocacy and/or appeals process. At direction of management, assists in the coordination of changes among departments.

Skills

Customer service, Inbound call, Call center, Customer support

Top Skills Details

Customer service,Inbound call,Call center

Additional Skills & Qualifications

• Bachelor's degree and one year of related work experience; or equivalent combination of education and related work experience

Preferred:

• Experience in the healthcare industry.

• Experience with customer servicing.

o Professional skills/knowledge and/or Technical skills/knowledge:

 Minimum:

• Effective verbal and written communication skills.

• Problem identification and resolution skills

• Basic knowledge of Microsoft Office applications. Including but not limited to Word, Excel, Outlook, and Power Point.

 Preferred:

• Strong critical thinking and problem-solving skills.

WEST: #prioritywest

#westpriority25