Employer Industry: Healthcare Solutions

Why Consider this Job Opportunity:
- Competitive pay
- Opportunity for career advancement and growth within the organization
- Flexible work solutions including remote options and hybrid work schedules
- Comprehensive benefits package, including health insurance coverage for you and your dependents on Day 1
- Tuition reimbursement and other professional development opportunities

What to Expect (Job Responsibilities):
- Screen calls from members and providers regarding the grievance processes
- Complete First Call Resolution cases and convert unresolved cases into standard grievances
- Generate acknowledgment letters and answer general appeal status questions
- Assist Investigation Specialists with grievance resolutions

What is Required (Qualifications):
- High School/GED required, Associate degree preferred
- 1 to 3 years of knowledge in Medicare Advantage, D-SNP, and Medicare Medicaid Plan (MMP)
- At least 2 years of customer service experience in the healthcare space
- Claims, medical terminology, ICD, CPT, and coding experience highly essential
- Ability to work collaboratively or independently, attention to detail, flexibility, and strong communication skills
- Willingness to work weekend and holiday rotations

How to Stand Out (Preferred Qualifications):
- 0-2 years of experience as an Rx Technician or Customer Service Representative in a healthcare-related service

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