What are the responsibilities and job description for the Grievance/Appeals Healthcare Specialist position at Siri IT Solutions Pvt Ltd?
Overview
We are seeking a skilled Business Analyst-Jr (Case/Appeals Resolution) to join our team. The ideal candidate will play a key role in analyzing business processes and identifying opportunities for improvement. If you have a passion for data analysis and problem-solving, we want to hear from you.
Job Description:
Required Level of Education and Preferred Level of Education: Bachelor’s / College Degree but high school is also considerable.
How many years of related experience are you looking for in your ideal candidate? At least 3 years working experience
Specific Systems Knowledge Required: Microsoft Office Suite, Intermediate Excel, Training will be provided on CLIENT's systems.
Top Daily Responsibilities:
1. Focuses on case resolution with emphasis of coverage issues to ensure no discrepancies exist among systems, with our members’ complaints.
2. Supports daily Business Case Development through timely analysis and resolution of member complaints by performing research and review through multiple systems.
3. Perform / timely follow up through member cases.
4. Ability to communicate with members when required.
Top (3) Required Skills Candidate Should Have:
- Analytical skills – a must, in order to perform accurately and timely on cases, to ensure a first time full resolution is achieved.
- Must be able to proactively work in a collaborative Team Environment, demonstrating development of positive relationships with peers.
- Great communication skills to timely provide feedback on issues that might affect multiple members.
- Flexibility to adapt to and to follow ongoing process changes.
Additional notes–
Membership Administration Case Excellence- (Members case Resolutions)
- Must be in San Diego
- Remote until it opens up and will have to go and pick up laptop etc
- CONTRACT ONLY
- Real people- not robots-have a human side to them- able to work in teams
- Good Communications as will be member facing and will be calling members to do resolution updates and member outreaches
- Prior Healthcare and Case resolution experience
- Analytic Skills to follow process and resolve cases
- Willing to embrace change- sometimes regularly
- Good listeners
- Be Trainable- 3-4 weeks of training. No Time Offs
- Good typing and Excel skills and Spreadsheets
How the team works - When members sign up for coverage and they have an escalation that CLIENT’s tier1, tier2, tier3 help desk cannot fix, HIRING MANAGER's team takes and resolves members escalated issues. They are the last stop in member escalations. When members call the call center, and the call center needs to do research, they don't keep the member on the call. They create a ticket and his team will do research on the eseclated matter. They will find a solution, close the ticket, and the call center person will call the customer back to let them know the resolution.
Top experience to be considered
- Healthcare Insurance Experience
- Healthcare Billing Experience
- Grievance/Appeals in healthcare setting
- Case management in healthcare setting
- Epic experience is a big plus
- Oracle experience is a big plus
- Healthcare Exchange experience
- Excellent research and analysis skills
- Excellent documentation skills
Job Type: Contract
Pay: $35.00 - $38.00 per hour
Expected hours: 40 per week
Schedule:
- 8 hour shift
Experience:
- Grievance/Appeals: 2 years (Required)
- Case management: 2 years (Required)
Location:
- San Diego, CA (Preferred)
Shift availability:
- Day Shift (Required)
Ability to Relocate:
- San Diego, CA: Relocate before starting work (Required)
Work Location: Remote
Salary : $35 - $38
