CareSource

Grievance & Appeals Resolutions Specialist III, State Insurance License in Accident and Health Required

CareSource

full-time

Posted on:

Location Type: Remote

Location: United States

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Salary

💰 $47,400 - $76,000 per year

About the role

  • Provide oversight of HICS and CTM system
  • Ensure full resolution of HICS and CTM cases within regulatory timeframes and defined requirements
  • Research, follow up and resolve discrepancies associated with membership eligibility
  • Analyze member eligibility and take appropriate actions to resolve issues across all eligibility systems
  • Oversee, analyze, and provide feedback to all areas that participate in the HICS and CTM case resolution
  • Develop, implement, and execute HICS and CTM training to business areas as needed
  • Analyze and evaluate operations to identify and suggest process improvements
  • Monitor and track HICS and CTM data
  • Identify irregular trends with HICS and CTM cases; work with other areas as appropriate to identify root causes and take appropriate steps for resolution
  • Document and report data to appropriate internal committees
  • Make outbound phone calls in support of Enrollment processes
  • Perform any other job duties as requested

Requirements

  • Associate Degree in business, finance or related field
  • Minimum of three (3) years of experience in customer service or claims experience
  • Prior experience in managed care or other healthcare industry is preferred
  • Enrollment, billing, finance, or data analysis experience is preferred
  • Proficient in Microsoft Office Suite to include Word, Excel, and Power Point
  • Basic experience with ACD systems
  • Basic experience with Call Management Systems
  • Excellent written and verbal communication skills
  • Strong interpersonal skills
  • Effective problem-solving skills with attention to detail
  • Ability to work independently and within a team environment
  • Familiarity with the healthcare field with knowledge of Medicaid and Medicare
Benefits
  • Health insurance
  • Retirement plans
  • Paid time off
  • Flexible work arrangements
  • Professional development
  • Bonuses
  • Wellness programs
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
data analysisenrollmentbillingclaims experienceHICSCTMprocess improvementsMicrosoft Office SuiteExcelACD systems
Soft Skills
written communicationverbal communicationinterpersonal skillsproblem-solvingattention to detailindependent workteamwork
Certifications
Associate Degree