Complaint and Appeals AnalystPrimary Location: Phoenix, AZ
Additional Locations: AZ-Phoenix Apply
- Acknowledge and respond to member complaints, orally or in writing
- Coordinate issue resolution among multiple departments within required time frame
- Provide guidance/coaching to frontline staff on specific cases
- Identify and trend systemic problems and make suggestions to improve or reduce the possibility of a reoccurrence
- Ensure the resolution appropriately addresses all issues raised in the complaint
- Communicate issue resolution, orally or in writing
- Monitor timeliness and ensure compliance with case work
- Strong verbal/written communication skills required.
- 1-3 years' experience in customer service & handling complaints
- Ability to deescalate difficult situations while displaying compassion and empathy
- Ensure each issues was reviewed appropriately prior to resolution
- Well organized with ability to manage, prioritize & meet deadlines of cases
- Experience with claims and benefits a plus
- Ability to communicate effectively and document accordingly.
- Behavioral health, Medicare and Medicaid experience a plus.
- Ability to handle difficult callers and while maintaining composure. Ability to multi-task using several different websites to obtain information.
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