Appeals Representative

Caring. Connecting. Growing together.

Primary Responsibilities

• Research and resolve written complaints and complex or multi-issue member & provider complaints submitted by consumers and physicians/providers
• Communicate by making outreach calls with appropriate parties (member and or provider) regarding appeals and grievance issues, implications and decisions
• Analyze and identify trends for appeals and grievances
• Apply knowledge/skills to basic, repeated activities
• Respond to standard requests and solve routine problems by following established procedures
• Work with others as part of a team and have work reviewed by others
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regard to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so
  

Required Qualifications

• Graduation is must
• 1.5+ years with good communication skills and interpersonal skills
• 6+ months of Customer calling Service Experience in a call center environment
• Analyzing and solving customer problems OR 1+ year of experience in a corporate environment will be added advantage
• Solid verbal and written communication skills
• Beginner level of experience with MS Word and Excel
• Good typing speed (English) and accuracy
• Proven result-oriented and goal-driven
• Demonstrates critical thinking abilities
• Willing to work night shifts