Appeal Resolution Specialist logs, tracks, and processes appeals and grievances. Sets up and maintains case files for each grievance and collects the information required by organizational policies and applicable regulations. Being an Appeal Resolution Specialist conducts research and coordination needed to evaluate, process, respond to, and refer or close appeals. May require an associate degree or equivalent. Additionally, Appeal Resolution Specialist typically reports to a supervisor. The Appeal Resolution Specialist works under moderate supervision. Gaining or has attained full proficiency in a specific area of discipline. To be an Appeal Resolution Specialist typically requires 1-3 years of related experience. (Copyright 2024 Salary.com)
LOCATION:
Remote MACU Footprint
SCHEDULE:
Tues - Sat 12:30-9
IMPORTANT INFORMATION:
JOB DESCRIPTION:
Experience
3-5 years of customer service or related experience and at least 6 months of Service Help Desk experience or 18 months of MACU experience
Education
High school diploma
Licenses, Certificates, Registrations
Must meet all expectations of an Agent 3
Computer/Office Equipment Skills
Basic computer operating skills. Advanced skills in Microsoft Office (Outlook, Word, Excel) Must have a good knowledge and confidence in working with Symitar. Type a minimum of 35 words per minute. 10-Key experience.
Managerial Responsibility
Have no supervisory/managerial responsibilities
Other Skills, Knowledge, and Abilities
Ability to work in a multi-channel (phone, chat, email) environment.
Ability to deliver exceptional member experiences in the most difficult situations.
Ability to show effective decision-making skills and recognize the appropriate action needed when reviewing higher risk situations.
Ability to work with many business partners in troubleshooting complex situations.
PHYSICAL ABILITIES / WORKING CONDITIONS
Physical Demands
Ability to talk on the phone, hear, sit, use hands to handle or feel and reach with hands and arms consistently
Vision Requirements
Close vision (clear vision at 20 inches or less)
Distance Vision (clear vision at 20 feet or more)
Weight Lifted or Force Exerted
Ability to lift up to 10 pounds consistently and up to 25 pounds occasionally
Environmental
There are no unusually environmental factors
Noise Environment
Moderate noise (business office with computers and printers, light traffic)
***This Job is not eligible to be performed in Colorado or Connecticut, either remotely or in-person.***
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