TEMPS for Customer Service Complaints unit.
The Complaints Unit is responsible for investigation and resolution of all member-initiated
complaints, complaint appeals, and Medicare billing appeals in compliance with regulatory
The Complaints Unit processes approx. 1,500-2,000 cases each quarter.
- The Unit aims to resolve all cases in an effective and timely manner.
- The investigation and resolution process for each case is often intricate and time consuming.
- In investigating each member complaint, the Complaints Team will outreach to all parties involved to obtain all necessary information to reach an informed determination or conclusion that is favorable or acceptable to the aggrieved party.
- In addition, the Complaints Team is responsible for generating all complaint related correspondence, tracking and trending all complaints data, identifying areas of concern and often formulating and implementing corrective measures.
- Reporting responsibilities also include generating different types of complaint reports for various internal committees, regulatory agencies, audits and as needed by Senior Management.
- The Complaints Team assists with developing New CSR Training and Refresher Trainings, and regularly provides on-site support to Management and CSRs with difficult cases and irate callers.
- Medicaid Appeals, Call Center and Complaint/Resolution experience
PAY RATE: $19.50p/hr.