Customer Service Representative

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.

Job title:

Customer Service Representative
Job Description:

Job Description:
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

Location:

Work@Home USAUnited States of America