Appeal Resolution Manager jobs in Ann Arbor, MI

This is a Hybrid Schedule

40 miles or less from Wixom 48393 you will be required to work two days per week in the office.

41 miles from Wixom 48393 you will be 100% Remote

Summary:

The Service Coordinator-Resolution Specialist is responsible for providing support to the J&B teams and Leadership with escalated issues. The role will focus on providing resolutions to member issues in an expedited manner while conducting quality checks and suggestions for improvement. The Service Coordinator-Resolution Specialist will assist in handling the order process from start to finish with the assistance of appropriate teams to provide a personalized experience with our escalated members.

Essential Functions:

• Understands the account flow process for a member, including resources needed to assist with the progression of an order
  • Addresses negative survey results by conducting account research, quality checks, and contacts members as needed to acknowledge feedback and provide solutions if applicable
  • Provides updates to inquiries from providers sent to the Provider Status Update email inbox
  • Responds to negative social media reviews to resolve in a timely manner
  • Follows the necessary steps to address formal complaints, according to J&B Medical’s Complaint Process
  • Submits process improvement suggestions to leadership that may improve the member’s order process or internal work process
  • Submits educational opportunities to ensure team members are coached accordingly (when needed) to follow the appropriate processes
  • May run reports to share with leadership and point of contacts regarding contracts with specified insurances
• Reviews account deactivation emails to identify trends and further research for member retention when possible
• Clearly documents all correspondence in the company database
• Communicates with members through phone calls, Web Portal, or texts as needed to provided needed updates
• Works closely with other cross functional departments such as Medical Documents, Dynamic Synergy, Verification Team, Quality, Shipping, etc.
• Other duties as assigned to meet business needs

Work Environment:

This job operates in a call center office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. This role is fast paced with matters that require a sense of urgency to resolve.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

This is a largely sedentary role. Individuals may need to sit or stand as need. This position may occasionally lift up to 25 pounds for files and supplies.

Position Type:

This is a full-time position. Days are Monday through Friday 8 hours of work per day, can vary from 6:00am to 6:00pm. Occasional evening and weekend work may be required as job duties demand.

Required Education and Experience:

• 3 years of related Customer Service experience with resolutions, retention and customer satisfaction.
• Knowledge of a CRM system and aspects of order processing, assessment and/or insurance process
• Proven ability to handle complexity of order process capably
• Experience handling escalated matters and providing timely solutions
• Knowledge of medical insurance
• Knowledge of healthcare/medical terminology
• College preferred. High School Diploma or GED required