Responsibilities
Grievance Handling:
- Investigate and resolve member grievances related to Medicare Part D drug coverage, claims, and pharmacy issues.
- Ensure all grievances are resolved within required CMS timelines and documented appropriately.
Communication:
- Act as a liaison between members, providers, and pharmacies for Medicare grievance resolution.
- Provide clear and empathetic communication throughout the grievance process.
Compliance:
- Adhere to all CMS (Centers for Medicare & Medicaid Services) guidelines and company policies.
- Maintain confidentiality of sensitive member information.
Documentation:
- Accurately document all interactions and resolutions in the client system.
- Prepare reports as required for compliance and auditing purposes.
Collaboration:
- Work closely with other departments to investigate and resolve grievances.
- Provide insights and feedback on recurring issues to improve processes.
Qualifications
Education and Certifications:
- Medical Allied Health graduate required (licensed/non licensed).
- Strong pharmacovigilance/ drug safety review experience (preferred but not required).
Experience:
- Minimum 1 year of experience in healthcare contact setting work experience (e.g., pharmacy technician, claims processor, provider services).
- Experience handling grievances or healthcare-related customer support in a contact center setting.
Other Requirements:
- Understanding of HIPAA and other healthcare regulations.
- Willingness to work flexible schedules, including US hours and holidays.
