Customer Service Representative

Explore meaningful roles that let you make an impact in healthcare while growing your career with purpose, innovation, and global opportunities. 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: Appeals and Grievance Coordinator 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 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. 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. Conducting non-biased, accurate, timely, and comprehensive investigation of all the facts related to the grievance/appeal. Thoroughly documenting all action taken on behalf of the member or provider to resolve the grievance/appeal. Ensuring that all grievances/appeals are processed in adherence to state and federal regulations. Location: View email address on click.appcast.io – United States of America Join our team, we are looking forward to talking to you! #J-18808-Ljbffr