Directly investigate and coordinate communications on escalated customer complaints. Resolve all complaints within established time frames while ensuring strict adherence to corporate compliance and federal HIPAA regulations.
Direct engagement in the coordination of internal policy review and response of customer audits.
Essential Duties and Responsibilities:
- Manage, coordinate and communicate with health plans and internal departments regarding escalated complaints.
- Contact clients in a timely and professional manner to deliver contract required information.
- Review and complete annual health plan audits with strict deadlines.
- Analyze and review policies for application towards internal correspondence and annual audits.
- Maintain working relationships with internal departments as well as external client contacts using a high level of both written and oral communication.
- Meet deadlines, working within tight time constraints.
- Correspond with management staff regarding customer service complaints including the gathering of data for problem resolution.
- Monitor and track via excel and/or other computer software tools the type and quantity of escalated complaints.
- Gather information necessary to respond to escalating complaints and/or grievances that extend beyond normal channels: complaints on appeal, legislative inquires and issues that meet the organization’s significant event policy.
- Produce internal reports on complaints and participant in monthly Quality Assurance meetings.
- Adhere to all company policies and procedures.
- Perform other duties as assigned.
Non-Essential Duties and Responsibilities:
- Seek opportunities to improve work environment.
- Be flexible with shifting daily priorities.
- Manage own time and work assignments effectively.
- Meet or exceed established standards of productivity and quality.
- High School Diploma or GED required.
- Associates or Bachelor Degree preferred.
- Lead or Quality Assurance experience preferred.
- Healthcare experience preferred.
- Ability to deal with complex problems involving a broad scope of issues while under pressure.
- Ability to effectively solve customer complaints in a timely manner by utilizing all tools available.
Other i.e. knowledge and skills:
- Must be proficient with Microsoft Office applications.
- Must type 40 wpm.
- Must have effective oral, written and interpersonal communication skills.
- Convey thoughts in a well-organized, concise manner. Use appropriate grammar and punctuation in written documents.