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Senior Resolution Representative

Community First Health Plans
Category | Clerical Job Schedule | Full Time Job Shift | Day Shift Job ID | 00071014 Post Date | Apr. 11, 2024 Department | Member Services/Resolution
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POSITION SUMMARY RESPONSIBILITIES
Responsible for assuring complaints, website inquiries, nurse advice administrative call reports and correspondence are responded to timely. Any databases utilized in this unit should be maintained, updated promptly and precisely as changes occur, to ensure compliance of CFHP policies and procedures. Provides for efficient operation of the member complaint process and the after hours activities process, and serves as the liaison between members and other departments in the health plan, including the Member Services telephone unit, Health Services Management, Network Management and Quality Management. Ensures compliance with the Health Insurance Portability and Accountability Act (HIPAA) related policies in regards to all aspects of operations within Member Services.

EDUCATION/EXPERIENCE
High school diploma or its equivalent is required. College or completion of commercial school courses in business functions is preferred. Must be computer literate, with a minimum of two years experience in Microsoft Word and Microsoft Excel or similar programs. Two years experience in office administration and Microsoft Access is preferred. Bilingual recommended (English/Spanish).

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