Job Description:
• Responsible for intake, investigation and resolution of appeals, complaints and grievances scenarios for all products.
• Ensure timely, customer focused response to appeals, complaints and grievance.
• Identify trends and emerging issues and report and recommend solutions.
• Review and resolution of clinical documentation, clinical complaints and appeals.
• Independently coordinate the clinical resolution with internal/external clinician support.
Requirements:
• Experience in reading or researching benefit language.
• Excellent verbal and written communication skills.
• Excellent customer service skills.
• 3-5 years of clinical experience required.
• RN with current unrestricted state licensure required.
Benefits:
• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs
• Confidential counseling and financial coaching
• Paid time off
• Flexible work schedules
• Family leave
• Dependent care resources
• Colleague assistance programs
• Tuition assistance
• Retiree medical access
• Many other benefits depending on eligibility
Apply Now
Apply Now