Customer Service Representative

Sagility

22d • Remote

About The Position

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.

Requirements

• The Appeals and Grievance Coordinator will be responsible for managing, coordinating, and resolving member and provider complaints, grievances, and appeals, ensuring compliance with state and federal regulatory requirements.
• Our Appeals and Grievance Coordinator will act as the primary investigator and contact person for the member and provider and perform research, resolution, and response to complaints on behalf of a member.

Responsibilities

• Sending appropriate acknowledgment of the grievance/appeal; educating the member or provider about the grievance/appeal process and their right to appeal to state or federal agencies (if applicable)
• Gathering all relevant information from the member or provider regarding the grievance/appeal and determining the appropriate resolution of the grievance/appeal per standard policies and procedures.
• Notifying the appropriate parties of the resolution and ensuring that all internal processes are completed to resolve the issue
• Conducts non-biased, accurate, timely, and comprehensive investigation of all the facts related to the grievance/appeal
• Thoroughly documents all action taken on behalf of the member or provider to resolve the grievance/appeal.
• Ensures that all grievances/appeals are processed in adherence to state and federal regulations

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed