[Remote] Customer Service Representative

Note: The job is a remote job and is open to candidates in USA. Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise. The Appeals and Grievance Coordinator will manage, coordinate, and resolve member and provider complaints, grievances, and appeals, ensuring compliance with state and federal regulatory requirements.ResponsibilitiesSending 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 proceduresNotifying the appropriate parties of the resolution and ensuring that all internal processes are completed to resolve the issueConducts non-biased, accurate, timely, and comprehensive investigation of all the facts related to the grievance/appealThoroughly documents all action taken on behalf of the member or provider to resolve the grievance/appealEnsures that all grievances/appeals are processed in adherence to state and federal regulationsSkillsResponsible for managing, coordinating, and resolving member and provider complaints, grievances, and appealsEnsuring compliance with state and federal regulatory requirementsAct as the primary investigator and contact person for the member and providerPerform research, resolution, and response to complaints on behalf of a memberSend appropriate acknowledgment of the grievance/appealEducate the member or provider about the grievance/appeal process and their right to appeal to state or federal agencies (if applicable)Gather all relevant information from the member or provider regarding the grievance/appealDetermine the appropriate resolution of the grievance/appeal per standard policies and proceduresNotify the appropriate parties of the resolutionEnsure that all internal processes are completed to resolve the issueConduct non-biased, accurate, timely, and comprehensive investigation of all the facts related to the grievance/appealThoroughly document all action taken on behalf of the member or provider to resolve the grievance/appealEnsure that all grievances/appeals are processed in adherence to state and federal regulationsCompany OverviewSagility is a technology and a transformation company that provides BPM services for healthcare centers. It was founded in 2021, and is headquartered in Westminster, Colorado, USA, with a workforce of 10001+ employees. Its website is https://sagilityhealth.com.