Resolution Analyst in Franklin, TN
Integrity Staffing Solutions is currently seeking a Resolution Analyst in the Franklin area. Integrity Staffing Solutions provides comprehensive professional level staffing services on a nationwide basis and has been bringing companies and professionals together almost 20 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!
Customer Service Representative is the face of the client and impacts members' service experience by the manner of how customer service inquiries and problems via telephone, internet or written correspondence are handled. Customer inquiries are of basic and at times complex nature. Engages consults and educates members based upon the member’s unique needs, preferences and understanding of the client's plans, tools and resources to help guide the members along a clear path to care.
Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors. Triages resulting in rework to appropriate staff. Documents and tracks contacts with members, providers and plan sponsors. The CSR guides the member through their member's plan of benefits, client policy, and procedures as well as knowing resources to comply with any regulatory guidelines. Creates an emotional connection with our members by understanding and engaging the member to the fullest to champion for our members' best health.Taking accountability to fully understand the member’s needs by building a trusting and caring relationship with the member. Anticipates customer needs. Provides the customer with related information to answer the unasked questions, e.g. additional plan details, benefit plan details, member self-service tools, etc. Uses customer service threshold framework to make financial decisions to resolve member issues. Explains member's rights and responsibilities by the contract. Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via the target system. Educates providers on our self-service options; Assists providers with credentialing and re-credentialing issues. Responds to requests received from Aetna's Law Document Center regarding litigation; lawsuits handled extensive file review requests. Assists in the preparation of complaint trend report. Assists in compiling claim data for customer audits.Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals. Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management. Review member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible. Performs financial data maintenance as necessary. Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received.
Customer Service experiences in a transaction based environment such as a call center or retail location preferred, demonstrating the ability to be empathetic and compassionate. Experience in a production environment.
- Hours: 8:30 – 5:00
- Pay Rate: $15.00
- Employment Type: Contract
- Limited medical and dental coverage for contractors and their families available immediately
- Opportunities for professional growth.
As an equal opportunity employer, Integrity Staffing Solutions is committed to a diverse workforce and a barrier-free application process. As part of the Integrity Staffing Solutions Accessibility Policy, if you have a disability and are having issues accessing any portion of our website or in applying for a job, please contact us for direct assistance by sending an email to email@example.com. Include your name, phone number, email address and the nature of your issue. Only communications regarding disability access issues will receive a response. A member of our staff will be in contact with you within 48 business hours, Monday-Friday, excluding holidays, to discuss the information you have provided and to help you complete your inquiry. Thank you for your patience and our team is looking forward to assisting you!!
INTEGRITY STAFFING IS AN EQUAL OPPORTUNITY EMPLOYER