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Aerotek Healthcare Resolution Specialist in Saint Louis, Missouri

Description:

The Resolution Specialist is responsible for managing complaints, incidents and accidents for designated Clients, in accordance with Client requirements and Policies and Procedures for Quality & Compliance.

Skills:

Medical claim, Customer service, Clerical

Top Skills Details:

medical claim, Customer service

Additional Skills & Qualifications:

• Document, review, investigate, resolve and provide follow up for all complaints and complaint issues reported for assigned clients within the specified timeframe

• Send complaint resolution letters to member/ beneficiary/ recipients per Client contract

• Compile daily/weekly/monthly complaint reports to be submitted to designated clients per contract

• Obtain responses within 24-48 hours from Transportation Providers to complaints and complaint issues

• Closely adhere to client service level agreements to ensure complaints do not go out of compliance

• Provide immediate follow up for complaint responses that are not submitted within the specified timeframe and enforce disciplinary measures as needed

• Respond to client, Program Director, or Account Executive inquiries sent via email, or fax, within the specified timeframe

• Ensure accuracy of information in report prior to deadline submission

• Triage issues and provide assistance to MTM’s internal departments with complaint issues

• Assist with monthly trending information in regards to potential network inadequacies, transportation provider deficiencies, and training opportunities to applicable departments; report trends to leadership for further review

• Monitor and report incident/accident issues

• Monitor and report issues of non-compliance to the leadership staff and Network Management as indicated

• Compile weekly/monthly summaries of incident/accident investigations, findings, and resolutions as required

• Send out monthly Quality & Compliance Tips to transportation providers and Network Management regarding prevention measures identified

• Ensure all training documents received per Q&C request

• Create relevant workflows, and tracking mechanisms as assigned

• Perform activities and participate in quality improvement projects for the Quality Improvement Program(s) as assigned to ensure ongoing compliance with URAC standards

Experience Level:

Entry Level

About Aerotek:

We know that a company's success starts with its employees. We also know that an individual's success starts with the right career opportunity. As a Best of Staffing® Client and Talent leader, Aerotek's people-focused approach yields competitive advantage for our clients and rewarding careers for our contract employees. Since 1983, Aerotek has grown to become a leader in recruiting and staffing services. With more than 250 non-franchised offices, Aerotek's 8,000 internal employees serve more than 300,000 contract employees and 18,000 clients every year. Aerotek is an Allegis Group company, the global leader in talent solutions. Learn more at Aerotek.com.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

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