Call Center Senior Representative Inbound

  • location: Cerritos, CA
  • type: Temporary
  • salary: $22.25 per hour
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job description

Call Center Senior Representative Inbound

Now hiring grievances/appeals Representatives for a large healthcare company in Cerritos

Pay: $22.25
Location: Tempe; zip code 90703
Working Hours: Monday-Friday; 8am-6pm
Duration:5 month temporary assignment

Responsibilities:
-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

Skills:
-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

Qualifications:
-High School diploma, GED, or equivalent certification

Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad. EEO Employer: Race, Religion, Color, National Origin, Citizenship, Sex, Sexual Orientation, Gender Identity, Age, Disability, Ancestry, Veteran Status, Genetic Information, Service in the Uniformed Services or any other classification protected by law. San Francisco Fair Chance Ordinance: Qualified applicants in San Francisco with criminal histories will be considered for employment in accordance with the San Francisco Fair Chance Ordinance.

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