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Grievance & Appeals Resolutions Specialist III, State Insurance License in Accident and Health Required

InsuranceInsuranceFull TimeRemoteSeniorTeam 1,001-5,000Since 30+ yearsH1B SponsorCompany SiteLinkedIn

Location

United States

Posted

73 days ago

Salary

$47.4K - $76K / year

Seniority

Senior

Associate Degree3 yrs expExperience acceptedEnglish

Job Description

Grievance & Appeals Resolutions Specialist III, State Insurance License in Accident and Health Required

CareSource

• Provide oversight of HICS and CTM system • Ensure full resolution of HICS and CTM cases within regulatory timeframes and defined requirements • Research, follow up and resolve discrepancies associated with membership eligibility • Analyze member eligibility and take appropriate actions to resolve issues across all eligibility systems • Oversee, analyze, and provide feedback to all areas that participate in the HICS and CTM case resolution • Develop, implement, and execute HICS and CTM training to business areas as needed • Analyze and evaluate operations to identify and suggest process improvements • Monitor and track HICS and CTM data • Identify irregular trends with HICS and CTM cases; work with other areas as appropriate to identify root causes and take appropriate steps for resolution • Document and report data to appropriate internal committees • Make outbound phone calls in support of Enrollment processes • Perform any other job duties as requested

Job Requirements

  • Associate Degree in business, finance or related field
  • Minimum of three (3) years of experience in customer service or claims experience
  • Prior experience in managed care or other healthcare industry is preferred
  • Enrollment, billing, finance, or data analysis experience is preferred
  • Proficient in Microsoft Office Suite to include Word, Excel, and Power Point
  • Basic experience with ACD systems
  • Basic experience with Call Management Systems
  • Excellent written and verbal communication skills
  • Strong interpersonal skills
  • Effective problem-solving skills with attention to detail
  • Ability to work independently and within a team environment
  • Familiarity with the healthcare field with knowledge of Medicaid and Medicare

Benefits

  • Health insurance
  • Retirement plans
  • Paid time off
  • Flexible work arrangements
  • Professional development
  • Bonuses
  • Wellness programs

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