- LA Care Health Plan (Los Angeles, CA)
- Lead Customer Solution Center Appeals and Grievances Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & Grievances ... to achieve that purpose. Job Summary The Lead of Customer Solution Center Appeals...solutions to handle irate members, and provide optimal customer service for internal and external customers. Must be… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & ... to support the safety net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will… more
- LA Care Health Plan (Los Angeles, CA)
- …and to support the safety net required to achieve that purpose. Job Summary The Customer Solution Center (CSC) Audit Readiness Specialist II is responsible ... end on all regulatory functions. Duties Audit readiness: Performs audit procedures for Customer Solution Center departments to ensure readiness; including… more
- CVS Health (Columbus, OH)
- …care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just ... transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. **Position… more
- LA Care Health Plan (Los Angeles, CA)
- …Preferred Required Training Physical Requirements Light Additional Information Department Specifics: Customer Solution Center Appeals and ... matter expertise in functional area to bridge business requirements and IT solutions ; provide technical direction and ensure compliance with best practice … more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Member Navigator II (Location- Metro Los Angeles) Job Category: Customer Service Department: Even MORE Outreach & Service ... net required to achieve that purpose. Job Summary The Customer Solution Center Member Navigator...of experience resolving health care eligibility, access, grievance and appeals issues, preferably in health services, legal services and… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- …healthcare providers with member benefits, eligibility, claims inquiry, claim reconsiderations and appeals . The Customer Service Representatives must be able to ... and communicate effectively with teams. + Transfer misdirected requests and offer solutions to non-routine issues. + Contribute to customer satisfaction and… more
- Brighton Health Plan Solutions, LLC (Melville, NY)
- … needs and concerns; demonstrate empathy and offer solutions . * Confirm customer understanding of the solution and provide additional customer education ... with member benefits, eligibility, claims inquiry, claim reconsiderations and appeals . This job description is not designed to cover...on ways to resolve problems to better serve the customer and/or improve productivity. * Offer solutions … more
- CVS Health (Tallahassee, FL)
- …may require coordination of responses from multiple business units. Ensure timely, customer focused response to appeals , complaints and grievance. Identify ... Anchored in our brand - with heart at its center - our purpose sends a personal message that...trends and emerging issues and report and recommend solutions . -Research incoming electronic appeals , complaints and… more
- US Tech Solutions (Orange, CA)
- …High School diploma or equivalent PLUS 2 years of experience as a call center agent or customer /member services representative in health care required; an ... Member Liaison Specialist to join our team. The Member Liaison Specialist ( Customer Service) will provide member service to seniors, persons with disabilities or… more
- US Tech Solutions (RI)
- …inquiries to the pharmacist team as appropriate. **Experience:** + 0-3 years in a customer service or call center environment managing 75 calls/day. + Six months ... and/or resolve coverage requests. + Escalate issues to Coverage Determinations and Appeals Learning Advocates and management team as needed. + Must maintain… more
- US Tech Solutions (May, OK)
- …inquiries to the pharmacist team as appropriate. **Experience:** 0-3 years in a customer service or call center environment managing 75 calls/day. Six months ... and/or resolve coverage requests. Escalate issues to Coverage Determinations and Appeals Learning Advocates and management team as needed. Must maintain compliance… more
- Surgery Care Affiliates (Panama City, FL)
- …dynamic group of physician-driven, specialty care businesses that allows us to customize solutions , no matter the need or challenge: + We connect patients to ... part of Optum and with our new Specialty Management Solutions business. + We have pioneered a physician-led, multi-site...responses and resolution. The PAR will function within the Center 's policies and procedures, support SCA Values, SCA Vision… more
- CVS Health (Franklin, TN)
- …care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just ... culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and...a trusting and caring relationship with the member. Anticipates customer needs. Provides the customer with related… more
- Cleveland Clinic (Beachwood, OH)
- …thorough benefits investigation and processes any necessary prior authorizations and/or appeals for pharmacy claims. + Explains benefit coverage and financial ... of results as needed. + Communicates with patients in a professional and customer -friendly manner in order to schedule the delivery of new and refilled medications… more
- Corewell Health (Grand Rapids, MI)
- …to Customer Service Leadership, when appropriate, to avoid unnecessary appeals and/or expedited requests. + Track all activity including communication for each ... products in a pleasant and expedient manner to ensure quality customer service and compliance with all legislative, regulatory and accreditation requirements.… more
- Ochsner Health (New Orleans, LA)
- …an accommodation to complete the application process, please contact our HR Employee Solution Center at ### (select option 1) or_** **_###@ochsner.org_** **_. ... business services/revenue cycle, front line registration, financial counseling, banking and/or customer service related job + Preferred -Prior working use of EPIC… more
- State of Colorado (Lakewood, CO)
- …things customer experience related: e-services, website, public education, contact center , and in-person customer service delivery. The CCXO will champion ... customer experience across all touchpoints, including the contact center , website, and in-person interactions, as well as developing recommendations for… more
- US Tech Solutions (May, OK)
- …sorting, email boxes, CAS maintenance, etc. Experience: . 0-2 years of experience in customer service or call center environment managing high volume calls. . 6 ... internal groups regarding determination status and results (seniors, pharmacists, appeals , etc). . Identify and elevate clinical inquiries to.... High School diploma or GED About US Tech Solutions : US Tech Solutions is a global… more
- US Tech Solutions (RI)
- …etc. 5% **Experience:** Preferred 0-3 years work experience required in a customer service position with high volume call center experience; preferably ... with other internal groups regarding determination status and results (seniors, pharmacists, appeals , etc.). 10% + Identify and elevate clinical inquiries to the… more