Grievance & Appeals Resolutions Specialist III (State Insurance License in Accid

About This Gig

Job Summary: Grievance & Appeals Resolution Specialist III is responsible to provide oversight of HICS and CTM system. Essential Functions: Ensure full resolution of HICS and CTM cases within regulatory timeframes and defined requirements Research, follow up and resolve discrepancies associated with membership eligibility Analyze member eligibility and take appropriate actions to resolve issues across all eligibility systems Oversee, analyze, and provide feedback to all areas that participate in the HICS and CTM case resolution Develop, implement, and execute HICS and CTM training to business areas as needed Analyze and evaluate operations to identify and suggest process improvement Monitor and track HICS and CTM data Identify irregular trends with HICS and CTM cases; work with other areas as appropriate to identify root causes and take appropriate steps for resolution Document and report data to appropriate internal committees Make outbound phone calls in support of Enrollment pr

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