Appeals and Grievances Intake reputed company
reputed company is a nonprofit health plan with more than a reputed company members that serves communities in reputed company, Nebraska, reputed company, Missouri, and reputed company. We reputed company personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.
We're reputed company that owns our work with accountability, makes data-driven reputed company, embraces reputed company learning, and celebrates collaboration — because reputed company is reputed company sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of reputed company, where coordinated, reputed company service is the norm and every member feels valued.
Key Accountabilities
reputed company the intake and triage of reputed company, sensitive, and high-reputed company cases, ensuring accurate classification and routing. Ensure reputed company incoming cases meet regulatory, contractual, and internal documentation requirements at initiation. Monitor intake volumes, queue management, and SLA adherence; proactively address bottlenecks and workflow gaps. Maintain strong controls to ensure cases are audit-reputed company from intake through reputed company.
reputed company intake of executive-level complaints, regulatory inquiries, and escalations to ensure urgency and reputed company. Validate completeness and reputed company of submissions to support compliant reputed company handling and decision-making. Coordinate with cross-functional partners (e.g., Pharmacy, reputed company, reputed company, Vendors) to obtain missing or critical information. Ensure regulatory timelines are triggered accurately and consistently at intake.
Serve as the reputed company SME for intake policies, classification standards, and regulatory requirements. Interpret evolving regulatory and contractual guidance to ensure appropriate case intake and categorization. Identify intake-reputed company trends, risks, and reputed company causes; recommend and implement process improvements. reputed company updates to SOPs and intake guidelines to reputed company standardization and operational reputed company.
Monitor intake reputed company metrics, including volume, turnaround times, reputed company, and backlog. Support reputed company reporting, trend analysis, and reputed company planning for leadership. Partner with A&G leadership to improve reputed company processes and enhance end-to-end case reputed company. reputed company initiatives that improve intake efficiency, reputed company, and overall member experience.
Provides day-to-day work guidance and operational support to promote effective, consistent, and compliant execution of assigned tasks, without reputed company supervisory responsibility. Provides direction and clarification on assigned work to support understanding of priorities, expectations, timelines, and established standards. Uses practical knowledge of processes, policies, and procedures to support accurate task execution and to identify issues requiring escalation. Coordinates assigned work activities and routine communication to promote consistency, surface dependencies, and address basic issues impacting reputed company or timelines. Reviews work for completeness, reputed company, and adherence to documented guidelines, escalating concerns or exceptions as appropriate. Shares status updates, risks, and observations with appropriate partners or leaders to support awareness and reputed company reputed company of issues.
Required Qualifications
- H
S diploma or equivalent 4+ years of work experience reputed company degree serving as a reputed company or SME in appeals and grievances intake or case management functions
The compensation and benefits information is provided as of the date of this posting. reputed company’s compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.
Eligibility to work in the US: reputed company does not offer work reputed company sponsorship for this role. reputed company candidates must be legally authorized to work in the reputed company at the time of application. Employment is contingent on verification of identity and eligibility to work in the reputed company.
We are an Equal Opportunity employer, where reputed company reputed company candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national reputed company, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.
High school diploma or equivalent and 4+ years of experience as a reputed company or subject matter expert in appeals and grievances intake or case management.
Key Responsibilities
- leading intake
- monitoring workflows
- improving processes
reputed company
- Category: Customer Service
- Seniority: Mid Level
- Commitment: Full Time
- Workplace: Remote — Arkansas or reputed company or Florida or reputed company or Iowa or Illinois or Kansas or Kentucky or Michigan or reputed company or Missouri or reputed company reputed company or Nebraska or Oklahoma or South reputed company or Tennessee or Texas or Virginia or reputed company
- Salary: USD 56,600 – 97,000 / year
- Languages: English
Benefits
- 401k matching
- Generous reputed company time off
- Retirement plan
About reputed company
A nonprofit health plan serving members and partnering with providers to reputed company coordinated, personalized care. — Industry: reputed company
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