Our client is currently seeking a Grievance Resolution Specialist in the area of Orange, CA!!
Responsibilities:
Address provider inquiries, questions, concerns in all areas including enrollment, claims submission and payment, benefit interpretation, and referrals/authorizations for medical care.
Verifies member eligibility, claims, and authorization status for providers.
Responsible for thorough follow-up and completion of all providers inquires or requests.
Outreaches to Health Network(s), providers, and collection agencies when appropriate to resolve claims billing, claims payment, and provider payment disputes.
Functions efficiently and productively in a high-volume call center while maintaining departmental productivity and quality standards.
Follows up with providers as needed.
Responsible for accurate, complete, and correct documentation into facets regarding all issues, inquiries, complaints, and grievances.
Routes escalated calls to the appropriate departments and/or supervisor.
Requirements:
1+ year call center experience with high call volumes or customer service experience analyzing and solving provider claims problems required
2+ years of claims experience required
Health Maintenance Organization (HMO), Medicare, Medicaid, and Health Services experience preferred
If this would be of interest to you or someone you might know, please don't hesitate to send your resume or questions to me directly at bkirking@judge.com.
Contact: bkirking@judge.com
This job and many more are available through The Judge Group. Find us on the web at www.judge.com
