Briljent LLC Healthcare Grievance and Appeals Representative in Indianapolis, Indiana
Briljent is currently seeking a Healthcare Grievance and Appeals Representative I to review, analyze, and process healthcare insurance grievances and appeals to determine company liability and entitlement. This role requires excellent customer service skills as well as strong attention to detail.Responsibilities:Conducts investigation and review of customer grievances and appeals involving the provision of service and benefit coverage issues.Contacts customers to gather information and communicate disposition of the case and document interactions.Generates written correspondence to customers such as members, providers, and regulatory agencies.Performs research to respond to inquiries and interprets policy provisions to determine the extent of the company's liability and/or provider's/beneficiaries entitlement.Responds to appeals from CS Units, Provider Inquiry Units, members, providers, and/or others for resolution or affirmation of previously processed claims.Ensures appropriate resolution to inquiries, grievances, and appeals within specified timeframes established by either regulatory/accreditation agencies or customer needs.Identifies barriers to customer satisfaction and recommends actions to address operational challenges.Requirements:HS diploma or equivalent.1-3 years' experience in health insurance including customer service experience; or any combination of education and experience, which would provide an equivalent background.Proven verbal and written communication skills including the use of proper spelling and grammar in a professional environment. Will be evaluated based on resume and email communications as well as phone interviews.Excellent organizational and interpersonal skills.PC proficiency including Microsoft Word and Excel as well as email.If you meet all of the qualifications and are interested in working with a fun and supportive company, apply today! More information about Briljent can be found at www.briljent.com.Briljent will not discriminate against any employee or applicant on the basis of age, color, marital status, race, religion, veteran status, disability (in compliance with the Americans with Disabilities Act), sex, sexual orientation, gender identity, or national origin or other status as protected by applicable law. Briljent will not discriminate against employees or applicants who inquire about, discuss, or disclose their compensation or the compensation of other employees or applicants.