$ads={1}
Overview:
TekWissen Group is a workforce management provider throughout the USA and many other countries in the world. Our client is a health insurance company. It offers different types of health care coverage plans that include individual and family, dental and vision, plans for employers, etc.
Engagement Description
Job Description:
- Analyze, investigate, and resolve appeals, complaints, and grievances.
- Provide comprehensive and thorough responses in compliance with CMS guidelines, state and federal regulations, and accreditations standards.
- Interact with internal and external customers and subject matter experts to gather information, build a case, and make decision to maintain or reverse appeal or grievance.
- Analyze and interpret systems data, contract language, regulatory provisions, and apply it to casework.
- Adhere to policies, procedures, and audit standards to remain compliant and audit ready.
- We are looking for individuals who have superior customer service/concierge skills and experience and are capable of making decisions based on gathered evidence and facts, working in a high stress, high volume, and heavily audited area.
- Currently, our team works remotely.
- Those selected for the position will be provided with a laptop. To work from home successfully, candidates must have a minimum internet speed of 24mbps.
- While working from home, most individuals benefit greatly by having a dedicated work area/office in their respective homes and an additional monitor.
- The monitor is not provided by Client.
Candidates should have the following skills and attributes:
- excellent verbal and written communication skills.
- have strong letter writing and proofreading skills.
- strong PC application and system skills- having the ability to navigate multiple computer systems and databases.
- be analytical, having the ability to examine a matter, the facts, contextual information and make an informed decision or implement and execute a reasonable, rational resolution.
- have the ability to work with a sense of urgency
- have high attention to detail and remain organized
- have high regard for quality work, accuracy, and confidentiality
- have previous customer service experience and excel at customer servicing.
- have the ability to use and apply previous experiences and knowledge when encountering new or unfamiliar situations
- professional in conduct
- ability to work independently or with minimal oversight
- ability to work in a fast paced environment with tight deadlines and high quality standards
- ability to work well under stressful circumstances
TekWissen® Group is an equal opportunity employer supporting workforce diversity.
Job Types: Full-time, Contract
Pay: $30.00 - $34.00 per hour
Application Question(s):
- Are you a local candidate to MI/WI/IN/IL/OH?
Experience:
- Grievance & Appeals: 1 year (Preferred)
Work Location: Remote
$ads={2}
