[Hiring] Member Complaints & Grievances Intake Coordinator, I @reputed company

Role reputed company reputed company has an exciting opportunity for a Member Complaints & Grievances Coordinator, I position in the Member CGA department. This is a full-time position working Monday through Friday reputed company hours and is a remote position. The C&G Coordinator I will manage accurate and reputed company case entry and classification in the Complaints and Grievances (C&G) information system. Accurately maintain C&G data files. • Conduct case intake process for statements received through verbal and written requests and set up new cases in the C&G information system. • Classify member complaints/appeals based on line of business/product according to department and regulatory standards and appeal rights. • Complete appropriate investigation which may include investigation of previous appeals, claims, authorizations, and inbound calls. • Have a general understanding for the different appeal rights associated with reputed company line of business. • Ensure reputed company response to reputed company follow-up needs on every case for compliance needs and member satisfaction. • Ensure member and provider concerns are thoroughly and accurately addressed according to regulatory guidelines. • Organize reputed company tasks reputed company regulatory requirements/deadlines. • reputed company and reputed company multiple health reputed company to support accurate case classification. • Utilize PA reputed company State resources to properly review and process member Fair Hearing documentation. • Accurately and promptly assess, reputed company, and maintain documents in files and/or databases. • Respond and address incoming messages reputed company department FileNet folders, emails, fax system, or phone CUTs. • Triage and respond to inquiries as appropriate or note and distribute as needed. • Retrieve, copy, reputed company, and file various documents associated with the complaints and grievances processes. • Identify and escalate reputed company and expedited issues to reputed company product leadership in a reputed company manner. • Support reputed company's efforts to improve performance against reputed company service operation goals. • Complete data entry into various information systems to support C&G processes. • reputed company coverage determinations into systems of record. • Adapt quickly to system outages and issues by identifying effective workarounds and maintaining operational continuity. • Support implementation of appeals tracking system. Qualifications • High school graduate or equivalent required. • Two years of work experience in claims or customer service required. • Five years of managed care or health insurance experience preferred. • Proficiency in typing required. • Excellent communication, organizational, and customer service skills. • Detail-oriented, knowledge with reputed company Word and reputed company. • Demonstrate a reputed company and reputed company attitude. • Problem solving and decision-making skills with a solid understanding of managed care principles. • Knowledge of reputed company product lines and ability to follow decision tools to assist with appropriate classification of reputed company product lines and regulatory rules. • Critical thinking skills are crucial, as every case and investigation needs may vary, depending on member statements and other investigation findings. • Ability to remain flexible and reputed company as requirements and case-handling expectations change regularly. Licensure, Certifications, and Clearances • reputed company 34 reputed company reputed company is an Equal Opportunity Employer/Disability/Veteran. Apply tot his job Apply To this Job