Research and resolve all escalations from Client’s members/providers that are addressed to client’s Executive Offices, Executive Leadership Team or the CEO (Presidential) as well as complaints coming from the Attorney General, State officials, and other internal areas for final resolution in a professional, timely, accurate and caring manner. Executive Response Specialist II are part of the Service Escalation Unit (SEU) team who handle the highest level of escalated issues within the organization for all lines of business (Medicare, Medicaid, PDP and Exchange).
Responsibilities: Gather, analyze and report verbal and written member and provider complaints, grievances and appeals Prepare response letters for member and provider complaints, grievances and appeals Maintain files on individual appeals and grievances May coordinate the Grievance and Appeals Committee Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information Assist with HEDIS production functions including data entry, calls to provider’s offices, and claims research. Manage large volumes of documents including copying, faxing and scanning incoming mail
- Benefits Administration
- Years of experience: 1 year
- Experience level:Experienced
Working hours: 8 AM - 5 PM
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