Senior Customer Service Representative

Senior Customer Service Representative needed in Phoenix, AZ Integrity Staffing Solutions is currently seeking a Senior Customer Service in the Phoenix area. Integrity Staffing Solutions provides comprehensive professional level staffing services on a nationwide basis and has been bringing companies and professionals together for over 12 years. At Integrity Staffing Solutions, we find the best, highest paying professional level positions within the top companies in the area. Most of the positions we identify will never be found in a newspaper or online because of the exclusive relationships we have with our clients who trust Integrity Staffing Solution's recruiting team to identify top talent to fill their critical hiring needs. Finding a top paying job at a great company is often like signing the contract of a lifetime; let us get to work for you today! Our client offers a broad range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities and health care management services for Medicaid plans. Their customers include employer groups, individuals, college students, part-time and hourly workers, health plans, governmental units, government-sponsored plans, labor groups and expatriates. As the first national, full-service health insurer to offer a consumer-directed health plan, our client continues to lead the way with their full line of consumer-directed health care products. Responsibilities:
• Receive incoming complaint filings and properly enter them into the complaint record system
• Review whether there is any possibility that some action might be needed to ensure the immediate health care needs of the member, and if so, engage the assistance of a person with appropriate clinical expertise to review the case
• Provide the filing party with written or oral acknowledgement of the receipt of the complaint, as required in the rules
• Be able to distinguish between the following ADHS/DBHS processes: a complaint, a TXIX appeal, an SMI appeal, and an SMI grievance
• Review complaint filings to ensure the information is sufficient to understand the nature of the complaint and obtain any needed information from the filing party or others
• Investigate the complaint-usually by obtaining through written or telephonic correspondence, specific and detailed information from a health care provider or RBHA staff about the allegations in the complaint
• Contact the filing party to discuss the information received by the Coordinator during the investigation of the complaint
• After obtaining needed information, determine and document the outcome of the complaint, including whether the concern has been substantiated and whether the concern has been resolved
• Document, in the complaint record the following: a. any plans for resolution b. any plans of correction c. evidence that he resolution and any plans of correction have been implemented d. any additional follow up referrals to Quality Management, Network Management, Grievances and Appeals, Fraud & Abuse and any other regulatory agencies e. and if the complaint process lasted longer than 10 days, the reason for the delay Skills:
• 2+ plus years' experience in the filed
• Must be able to work in a fast paced environment with multiple competing and changing priorities
• Must be computer savvy
• Must be able to adapt quickly Additional Details:
• Pay Rate: $13.00 per hour
• Hours: Full Time
• Employment Type: Contract
• Limited medical and dental coverage for contractors and their families available immediately
• Opportunities for professional growth. Integrity Staffing Solutions is an Equal Opportunity Employer. All job offers are contingent upon the successful completion of a background check and drug screen. OPENAF AFCB01 xistaffenterx