Senior Resolution Specialist

POSITION SUMMARY/RESPONSIBILITIES

Demonstrates comprehensive knowledge of all Community First Insurance products including third party administrative services to resolve member inquiries. Use their knowledge to resolve member inquiries through the secure member portal, complete correspondence request and respond to members or regulatory agencies when appropriate. Assist members in navigating benefits, services, complaint and complaint appeals processes and provide education and support to access care and services. They may also assist members in accessing non-covered services, such as those provided in other social services or community programs. Additionally, they may be called upon to participate in other interdepartmental processes, as needed. Ensures compliance with the Health Insurance Portability and Accountability Act (HIPAA) related policies about all aspects of operations within Member Services.

EDUCATION/EXPERIENCE

Bachelor’s degree in business, health care or related field with one year’s experience in the managed care industry is required. Minimum of four years’ experience in health insurance, or customer service industry, can be substituted for education. Complaints and appeals resolution or quality improvement management experience is highly preferred.