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Insurance Complaints and Appeals Associate

Company: US Tech Solutions
Location: Newark
Posted on: March 27, 2020

Job Description:

Job DescriptionUS Tech Solutions is seeking a--"Insurance Complaints and Appeals Associate"--for 6+ Months (Contract) with a client in--Newark, NJ?Job summary:------------------Manages resolution of complaints and/or appeals that have been escalated to client executives or regulatory entities within prescribed timeframes as mandated by the regulatory entity and per designated quality standardsResponsibilities:------------------Assesses cause(s) of complaint/appeal, conducts thorough research of issue(s), determines required course of action and final disposition.------------------Interacts with relevant parties to facilitate timely and accurate complaint/appeal resolution.------------------Authorizes administrative exceptions which may involve claim adjustment resulting in payments at higher threshold levels so as to bring closure to the complaint/appeal.------------------Contacts relevant party(ies) to acknowledge receipt of the complaint/appeal and uses probing techniques to clarify open issues, obtain additional relevant information and/or secure records necessary to complete investigation and bring issue to final resolution.------------------Review business team representative/vendor representative telephone calls with customers to verify accuracy of information related to complaint/appeal.------------------Develops customized, timely, accurate, detailed correspondence, for delivery to relevant party(ies), detailing case and final resolution. Correspondence may be used to educate party(ies) on benefit plan provisions and/or application of plan guidelines.------------------Responds to regulatory entity or members/providers, both verbally and in writing, regarding issue details and final determination made by client to close the complaint/appeal. Each response must be customized to the specific situation and address all issues presented by the member/provider.------------------Partners with Legal Department to review and finalize appeal determinations.------------------May prepare materials for and may attend case study meetings facilitated by designated internal or external parties.------------------Other duties as assigned.Education/ Experience:------------------Requires five years of business experience which must include two+ years of correspondence and/or telephone customer service experience screening, investigating and examining inquiries.------------------Experience in claims processing necessary.------------------Ability to navigate the various claims and service operations systems.------------------Healthcare industry experience helpful.Skills and Abilities:------------------Requires the ability to understand and use language correctly, to be determined by the Language skills test.------------------Requires keyboarding proficiency.------------------Requires the ability to perform basic arithmetical calculations.About US Tech Solutions:---- Your talent, our opportunities - This is the premise behind US Tech Solutions.You have the skill we have the opportunity. As a team, we work passionately for you to get the right career opportunity across industry verticals and functions. For past sixteen years, leading GlobalCompanies and Fortune 500 come to us to get the right talent. Whether you want to work as full-time, contractor or part-time, technical or non-technical our talent consultants will connect with the right career opportunity globally.Connect with our talent team today.USTECH was founded in 2000 by Manoj Agarwal. Today, we are a global firm offering talent solutions to 150 customers including 20% of Fortune 500 across Financial Services, Healthcare, Life Sciences, Aerospace, Energy, Retail, Telecom, Technology, Manufacturing, and Engineering. We are headquartered in New Jersey with 40 global locations across the USA, Canada, Europe, and India. Deloitte has recognized USTECH as one of the fastest growing private businesses for the past five consecutive years and INC 500 for the past three. We have also been rated "The Top Business in the US" by Diversity Business since 2011. To learn more about how US Tech Solutions visit our website: www.ustechsolutions.com."US Tech is an Equal Opportunity Employer" and "US Citizens & all other parties authorized to work in the US are encouraged to apply."Apply: Interested candidates are requested to send their resume to--Somdip at Somdip@ustechsolutionsinc.com

Keywords: US Tech Solutions, Newark , Insurance Complaints and Appeals Associate, Other , Newark, New Jersey

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