Job Description
Innovative, Dynamic, Fast Pace and Collaborative, these are just some of the words that our employees use to describe us but hey – don’t just take it from us – become a part of BroadPath today and experience our Culture of Constant Connection! BroadPath is immediately hiring Appeals and Grievance Coordinator to work from home, we want you! The Appeals and Grievance Coordinator will be responsible for managing, coordinating, and resolving member and provider complaints, grievances, and appeals, ensuring compliance with state and federal regulatory requirements. Our Appeals and Grievance Coordinator will act as the primary investigator and contact person for the member and provider and perform research, resolution, and response to complaints on behalf of a member.
Responsibilities
- Explain medical plans to members, pharmacies, any additional verified calls with whom agents work with to resolve member issues
- Handle updates to members accounts, such as adding/editing basic information (Address,Telephone, PCP, etc.)
- Handle mail order items and review as needed with the caller
- Handle basic customer issues such as complaints, appeals, prescription/PCP issues or concerns
- Handle billing concerns such as billing issues, refunds, escalations as needed
- Actively listen to the caller to verify what individual/department/pharmacy will need to be contacted in order to work together to resolve the issue
- Work with the identified individuals/departments regarding any of the above call scenarios in order to resolve the caller’s issue
- Effectively navigate and utilize a knowledge base system on every call
- Adhere to all call metrics as set forth by the client including Schedule Adherence, Average
- Handling Time, After Call Work and CSAT scores (Customer Satisfaction Scores) if applicable
- Have excellent schedule adherence – time management is a must
- Be dependable, organized and service minded
- Have quality focus and are detail oriented
- Ensure compliance with BroadPath, Client, and HIPAA regulations
Basic Qualifications
- Previous customer service experience required
- Must be detail oriented.
- Healthcare/Exposure to healthcare environments
- Previous Call Center Experience
- Must be willing to work in CST time consistently.
- Effectively communicate via written and spoken word – effectively speaking and communication with the caller is key.
- Must be able to multitask in real time for notes and effectively communicate to Supervisor/SMEs how assistance is needed in order to resolve the issue as needed.
- Computer literate (Microsoft Windows, keyboarding skills, strong systems aptitude). Must be comfortable with having open multiple browsers/tabs at any given time and ability to navigate screens.
- Maintain balanced performance in areas of production and quality
- Maintain confidentiality and project a professional business image
- Positive attitude and ability work independently from home, as well as with a team
- 100% attendance is required during training: No time off within the first 60 days of employment.
- Responsible for providing your own 19″ monitor or larger with VGA or HDMI port with corresponding cable, USB wired mouse, ethernet cable, and optional USB wired keyboard
Position Disclaimer
- Candidates Must Live in the Specific Counties within the listed States to Be considered
- ACCEPTABLE STATES FROM DOC ABOVE: AL, AZ, AR, CO, CT, FL, GA, IL, IN, KY, LA, MI, MN, MO,MS, NC, NJ, NM, NV, OH, OK, PA, SC, TN, KY, TX, UT, VA, WA, WI, WV
Our Pharmacy Customer Service Representatives will love the following benefits & perks!
- Invitation to join our Inclusivity, Diversity, Equity, + Action Committee
- Access to BroadPath’s Limited Medical Plan starting first of the month after 60 days of
- employment. After one (1) year of full-time employment, you will receive access to our Major
- Medical Plan, 401K, and our one of a kind “Bhive Kit;” which includes a camera that allows you
- to join our Connected Culture!
- Uncapped Employee Referral Program & Weekly Pay
Preferred Qualifications
- Previous successful work at home experience