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Pay Rate: $18
Location: Remote
Shift: 8am – 4:30pmCT / 8:30am – 5pmCT / 9am – 5:30pmCT
Training Schedule: 9am – 5pmCT (2 weeks of training)
6-Month Opportunity w/ Potential to Extend
Job Justification:
This position will assist in addressing a backlog of appeal volume, as well as addressing MassHealth appeal volume which is expected in Q4. You will also be responsible for triaging complaints, grievances, and member appeals based upon specific regulatory requirements for Specialists II. You will have minimal interaction with assigned market/client contacts, as well as various internal departments. Ensuring that all mandated turnaround times are met as well as required processes and workflows are adhered to will also be expected.
Job Responsibilities:
Complaint/Grievance/Appeal triage member appeals in accordance with State and/or Plan guidelines.
Ensure all components of the triage process are complete for the specialists to resolve cases.
Worker will be assigned cases in Salesforce, they will read the content of the appeal, categorize in Salesforce, generate an acknowledgement letter and send to the dental consultants for review. The final piece will be to sent out a resolution letter.
Expected to solve 2 – 3 cases per hour, achievable for focused individuals
Experience Needed:
Do not need Salesforce experience but if they do (or have any CRM Tool experience) it is a plus
Call Center background would work well, even though they are not fielding calls in this role, but typically call center experience comes with fast paced, hyper focused, and self-discipline
Having appeals experience or dental/medical insurance experience or processing claims experience will be a plus
Need at least a High School Diploma or GED
Must take a Typing Test for WPM Accuracy
