Overview:

TekWissen Group is a workforce management provider throughout the USA and many other countries in the world. Our client is a health insurance company. It offers different types of health care coverage plans that include individual and family, dental and vision, plans for employers, etc.

Job Description

Dept: Grievance & Appeals Coordinator

Engagement Description

• Analyze, investigate, and resolve appeals, complaints, and grievances.
• Provide comprehensive and thorough responses in compliance with CMS guidelines, state and federal regulations, and accreditations standards.
• Interact with internal and external customers and subject matter experts to gather information, build a case, and make decision to maintain or reverse appeal or grievance.
• Analyze and interpret systems data, contract language, regulatory provisions, and apply to casework.
• Adhere to policies, procedures, and audit standards to remain compliant and audit ready.

Top 3 Required Skills/Experience

• Critical thinking, problem solving, analytical skills
• Letter writing and proofreading
• 2 years Customer service/concierge services

Required Skills/Experience – The rest of the required skills/experience. Include:

• PC Applications
• Excellent verbal and written communication skills
• Organizational/Time Management
• 2 years health insurance experience and familiarity with health insurance state and federal regulations

Preferred Skills/Experience – Optional but preferred skills/experience. Include:

• Project Management

Education/Certifications – Include:

• Bachelor’s Degree in English, Communications, or related field preferred.

TekWissen® Group is an equal opportunity/affirmative action Employer (m/f/d/v) supporting workforce diversity.

Job Types: Contract, Full-time

Pay: Up to $34.00 per hour

Application Question(s):

• How many years of experience do you have in a call center (Out bound or inbound calls)?Are you familiar with CMS guidelines, State and federal regulations?
• What is your highest education qualification?

swaroop.k@tekwissen.com;Srinivasreddy.j@tekwissen.com;venkat@tekwissen.com
Hello Team,

Kindly post the below job in Indeed, Indeed
Recruiter : ANISETTI KARUNA
Recruiter Email : karuna.a@tekwissen.com

Job Title : Grievance and Appeal Coordinator / Customer Service
JCOM ID : 17258
Payrate : 34
Status : Requested

Skillset: Critical thinking, problem solving, analytical skills Letter writing and proofreading 2 years Customer service/concierge services

Questions:
How many years of experience do you have in a call center (Out bound or inbound calls)?
Are you familiar with CMS guidelines, State and federal regulations?
How many years of experience do you have in Health insurance and federal regulations?
What is your highest education qualification?

• How many years of experience do you have in Health insurance and federal regulations?
• Do you know Letter writing and proof reading?
• Do you have Bachelors Degree?

Work Location: Remote

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