Call Center Senior Representative Inbound
Now hiring grievances/appeals Representatives for a large healthcare company in Cerritos
Location: Tempe; zip code 90703
Working Hours: Monday-Friday; 8am-6pm
Duration:5 month temporary assignment
-Responsible for reviewing, analyzing and processing policies related to claims events to determine the extent of the company's liability and entitlement.
-Conducts investigation and review of customer grievances and appeals involving provision of service and benefit coverage issues.
-Contacts customers to gather information and communicate disposition of case; documents interactions.
-Generates written correspondence to customers such as members, providers and regulatory agencies.
- Researches administrative or non-clinical aspects of the appeal, e.g. eligibility, benefit levels, overall adherence to policies and practices.
- May make decision on administrative appeals where guidelines are well documented and involve limited discretion.
- Prepares files for internal or external review by analysts, medical staff or outside consultant.
- Triages clinical and non-clinical inquiries, grievances and appeals, prepares case files for member grievance committees/hearings.
Working hours: 8:00 AM - 6:00 PM
-1-3 years of claims processing experience
-Ability to perform comfortably in a fast-paced, deadline-oriented work environment
-Ability to solve problems and analyze complex situations under pressure
-Must be able to work independently and have critical thinking skills
-High School diploma, GED, or equivalent certification
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