Research Analyst

• Research and resolve customer grievances and complaints timely and accurately within CMS guidelines
• Perform root cause analysis and recommend systemic/process corrections when necessary
• Communicate identified resolutions to customers verbally and/or in writing per delivery method and customer request
• Accurately identify and document customer complaints from customer service notes, correspondence, or recorded interactions
• Utilize program processes and systems to research assigned grievance cases in their entirety and determine appropriate resolutions
• Identify and document resolution and root cause for assigned grievances and report trends to management for escalation
• Prepare reports as requested by management and display technical accuracy and conformity to company policies
• Ensure communications follow CMS Guidance and maintain HIPAA regulations within the immediate environment
• Ensure documentation is detailed and concise in member records
• Identify need for outbound calls to validate information and conduct member outreach
• Communicate courteously and professionally with coworkers, management, staff, customers, and others
• Conform with all regulations, policies, work procedures, and instructions; respond promptly to correspondence and faxes
• Participate in quality assurance, compliance, in-service, and continuing education activities as requested by the company
• Perform other duties and responsibilities as required

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