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Responsible for managing to resolution complaint/appeal scenarios for all products, which may contain multiple issues and may require coordination of responses from multiple business units. Ensure timely, customer focused response to complaints/appeals. Identify trends and emerging issues and report and recommend solutions.
Job Responsibility:
Managing to resolution complaint/appeal scenarios for all products
Ensuring timely, customer focused response to complaints/appeals
Identifying trends and emerging issues and report and recommend solutions
Coordinating responses from multiple business units
Requirements:
1 year experience that includes both HMO and Traditional claim platforms
1 Year experience working with Medicare, benefits, compliance and regulatory analysis, special investigations, provider relations, customer service or audit experience
High School or Equivalent
Nice to have:
Claims experience
Experience in reading or researching benefit language in Summary Plan Description (SPDs) or Certificate of Coverage (COCs)
Experience in research and analysis of claim processing
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