FIND_THE_RIGHTJOB.

Research Specialist

Sherwood, United States

Research Specialist

Job Summary:
To handle Commercial appeals and reconsiderations, Commercial customer service mail correspondence, Commercial web inquiries, internal email inquiries, and route complaints received to Professional Relations. Maintains all reporting to ensure compliance.

Safety Sensitive: This position is classified as safety sensitive, meaning the duties require a high level of alertness, sound judgment, and accuracy, which directly impact the health and well-being of members. As such, this position may be subject to drug testing in accordance with company policy and applicable laws.

Primary Job Responsibilities:

Completes all appeals within a thirty (calendar) day turnaround time; maintains appeals log.
Completes all reconsiderations within a seven (business) day turnaround time; maintains reconsideration log.
Completes all customer service mail correspondence within a five (business) day turnaround time. This includes, but is not limited to, Claim Status Inquiries, Refund Disputes, Insurance Verifications, Check Re-mail requests, Copies of checks request, and check re-issue requests.
Responds to all EOB inbox emails within a 24 hour turnaround time. Verify HIPAA and providing a resolution for the email inquiry.
Responds to all internal AR Research emails within a three (business) day turnaround time. This includes letter requests, claim status inquiries, etc.
Receives all provider complaints and requests necessary documentation from provider and sends acknowledgement letter to the complainant. Routes all documentation received to Professional Relations to proceed with the complaint.
Stays abreast of benefit changes, new enrollments and group terminations as provided by manager. Remaining familiar with available resources of information to resolve problems and answer questions.
Prepares monthly and quarterly reports to be provided to Operations Admin Assistant the first of each month.
Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.

Minimum Qualifications: Will accept any suitable combination of education, training or experience. Position requires a high school diploma or GED plus 2 years insurance operations experience.

Position also requires the ability to understand and apply state regulatory guidelines to the dispute process and the ability to remain familiar with available sources of information to resolve problems and answer questions and advanced experience working with spreadsheet software and intermediate experience working with alphanumeric data entry and word processing and basic experience working with 10-key and database.

Similar jobs