TekWissen is a global workforce management provider headquartered in Ann Arbor, Michigan that offers strategic talent solutions to our clients world-wide. Our client is a health insurance company. It offers different types of health care coverage plans that include individual and family, dental and vision, plans for employers, etc.
Engagement Description:
Process appeals and grievances, analyse, research, and provide comprehensive responses in accordance with established regulatory and accreditation guidelines.
Contact customers to gather information and communicate disposition of case.
Conduct pertinent research in order to evaluate, respond to, and finalize case.
Familiar with standard concepts, practices, and procedures for analysing, interpreting data and applying contract and regulatory provisions.
High School Diploma or GED required.
Bachelor's Degree in English, Communications or related field preferred.
Two (2) years customer service experience required.
Two (2) years health insurance experience and familiarity with health insurance state and federal regulations preferred.
Strong project management skills preferred.
Top 3 Required Skills/Experience -
Experience handling a large load of work in a fast-paced environment and have computer skills!
Insurance, Medicare/CMS knowledge
Customer Service Experience
Required Skills/Experience - The rest of the required skills/experience. Include:
Writing Letters
Analytical thinker
Research Skills
Multi-task
Preferred Skills/Experience - Optional but preferred skills/experience. Include:
Grievance and Appeals experience.
Degree in Healthcare/computer skills
Experience in analyzing a claim
Experience in classification between a grievance/appeal/organizational determination.
Letter writing
Basic computer skills. How to save a PDF, how to navigate excel, learning new systems
Education/Certifications - Include:
Healthcare, English
TekWissen® Group is an equal opportunity employer supporting workforce diversity.