Senior Resoluation Specialist

POSITION SUMMARY/RESPONSIBILITIES:
Comprehensive knowledge in the area of Health Insurance Exchange (HIE) to resolve member service complaints, appeals, Health Insurance Response System (HICS) inquiries, and correspondence via member portal/website, which includes responding to members or regulatory agencies when appropriate. Ensures all member oral or written complaints and appeals are acknowledged, investigated, and resolved, ensuring timely review and resolution by the member and/or regulatory agencies. Able to navigate and understand third-party software utilized for HIE member eligibility and payment status. Ensures compliance with the Health Insurance Portability and Accountability Act (HIPAA)-related policies with regard to all aspects of operations within Member Services.

EDUCATION/EXPERIENCE:
A bachelor's degree in business, healthcare, or a related field with at least two years of experience in the managed care industry is required. A minimum of five years of experience in the managed care industry may be substituted for college education. Complaints and appeals resolution or quality improvement management experience is preferred.