Bourbonnais, United States
over 1 year ago
- Processes coverage determination requests received by mail, fax, electronic portal or telephone.
- Works in various queues to ensure proper handling of all processes related to coverage determination requests.
- Works with time sensitive material and must adhere to mandates turnaround times on all work.
- Responds to inquiries from customers for information and assistance related to coverage determinations.
- Performs research to respond to inquiries and interprets policy provisions to determine most effective response.
- Seeks assistance with complex customer services issues.
- Makes outbound notification calls to members and/or their appointed representatives regarding status of requests.