Senior Resolution Specialist

University Health System; San Antonio; Presencial; CLP 20.000.000 - 40.000.000; Jornada completa

Descripción de la vacante

A healthcare organization in San Antonio, Chile, is seeking a candidate with comprehensive knowledge of insurance products and experience in managed care. The position involves resolving inquiries and complaints from members, ensuring timely resolution, and providing assistance during member walk-ins. A Bachelor's degree in business or health care is required, along with relevant work experience in the health insurance industry.

Formación

• At least one year of experience in the managed care industry is required.
• Minimum of four years’ experience in health insurance or customer service industry can be substituted for education.
• Complaints and appeals resolution or quality improvement management experience is also preferred.

Responsabilidades

• Comprehensive knowledge of all Community First insurance products.
• Specializes in Marketplace inquiries and complaints.
• Ensures all members' inquiries, complaints and appeals are acknowledged and resolved.

Educación

Bachelor’s degree in business, health care or related field

Descripción del empleo

POSITION SUMMARY/RESPONSIBILITIES

Comprehensive knowledge of all Community First insurance products including STAR Medicaid, Children’s Health Insurance Plan (CHIP, CHIP Perinate, CHIP Perinatal, CHIP Perinatal Newborn, University Family Care Plan (UFCP), Marketplace (University Community Care Plans UCCP), Commercial, Medicare Advantage Alamo Plan HMO, Medicare D-SNP HMO to resolve member inquiries, complaints, and appeals. Specializes in Marketplace inquiries and complaints received through the Health Insurance Casework System (HICS) from Centers for Medicare & Medicaid Services (CMS), Authorities to Approve (AA), and correspondence received via member portal/website. This also includes responding to member or regulatory agencies when appropriate and assisting with member walk-ins. Ensures all members' oral or written inquiries, complaints and appeals are acknowledged, investigated and resolved, ensuring timely review and resolution by member and/or regulatory agency. Able to navigate and understand third party software utilized for member eligibility and payment status.

EDUCATION/EXPERIENCE

Bachelor’s degree in business, health care or related field with at least one year of experience in the managed care industry is required. Minimum of four years’ experience in health insurance or customer service industry can be substituted for education. Complaints and appeals resolution or quality improvement management experience is also preferred.