Job Description
remote - may require the odd trip to the office to process mail
Role Responsibilities:
Point of contact for Health Plan member grievances and internally identified potential quality of care issues PQI. Responsible for coordinating the process with receipt and initial processing including data entry record requests and follow ups for member grievances and other quality of care concerns from internal and external sources.
Maintains documentation in databases as required coordinates and communicates with provider offices and other involved entities ensuring documentation is requested and received while managing TATs within Health Plan timelines 24 hours to 10 days depending on type of request.
Healthcare Experience
Open to remote with some in-office days
Microsoft experience
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