Medicare Complaints & Data Coordinator

Qlarant; Dallas (TX); On-site; USD 32,000 - 48,000; Full time

Job summary

Qlarant is a not-for-profit corporation that partners with public and private sectors to improve health care and human services. It handles complaints related to Medicare Advantage and Prescription Drug Programs, interviewing subjects and researching cases to determine disposition.

The role involves communicating with beneficiaries, plans, pharmacies, and providers to resolve concerns, evaluating facts, and preparing findings for Level II review. Background in healthcare or Medicare is preferred.

Qualifications

• Minimum High School Diploma or GED required.
• 0 - 2 years of experience required; 2 - 4 years preferred.
• Call Center experience preferred.
• Data Entry experience preferred.
• Healthcare or Medicare experience preferred.

Responsibilities

• Communicates with beneficiaries, plans, pharmacies, and providers as needed to resolve complaints.
• Evaluates the facts of a complaint and researches additional information as necessary.
• Compiles findings and determines if appropriate for closure or presentation to Level II team.
• Handles a wide variety of confidential situations.
• Performs data entry of complaints into the case management system and a variety of other databases.
• Performs minor background research on subjects of interest as required for the screening of complaints.
• Prepares appropriate letter templates and/or revises the content based on the facts presented in the complaint.
• Communicates with external customers including beneficiary or individual complainants, representatives from the Senior Medicare Patrol, Plan Sponsors, CMS, and others.

Skills

Communication skills

Data entry

Call center experience

Research and analysis

Education

High school diploma or GED

Tools

Case management system

Databases

Job description

Qlarant is a not-for-profit corporation that partners with public and private sectors to improve health care and human services. It handles complaints related to Medicare Advantage and Prescription Drug Programs, interviewing subjects and researching cases to determine disposition.

The role involves communicating with beneficiaries, plans, pharmacies, and providers to resolve concerns, evaluating facts, and preparing findings for Level II review. Background in healthcare or Medicare is preferred.