Customer Service Coordinator I
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Job Location:
Monthly Salary:
Posted on:
30+ days ago
Vacancies:
1 Vacancy
Job Summary
Qlarant is a not-for-profit corporation that partners with public and private sectors to create high quality safe and efficient delivery of health care and human services programs. We have multiple lines of business including population health utilization review managed care organization quality review and quality assurance for programs serving individuals with developmental disabilities. Qlarant is also a national leader in fighting fraud waste and abuse for large organizations across the addition our Foundation provides grant opportunities to those with programs for under-served communities.
Best People Best Solutions Best Results
Job Summary:
Receives complaints form a variety of sources. Interviews complainants or beneficiaries concerning the Medicare Advantage or Prescription Drug Programs to determine disposition of case. Researches subjects and beneficiaries of received complaints.
Essential Duties and Responsibilities:
- Communicates with beneficiaries plans pharmacies and providers as needed to resolve complaints.
- Evaluates the facts of a complaint and researches additional information as necessary.
- Compiles findings and determines if appropriate for closure or presentation to Level II team.
- Handles a wide variety of confidential situations.
- Performs data entry of complaints into the case management system and a variety of other databases.
- Performs minor background research on subjects of interest as required for the screening of complaints.
- Prepares appropriate letter templates and/or revises the content based on the facts presented in the complaint.
- Communicates with external customers including beneficiary or individual complainants representatives from the Senior Medicare Patrol Plan Sponsors CMS and others.
Required Skills
To perform the job successfully an individual should demonstrate the following competencies:
- Business Expertise- Good understanding of how assigned duties contribute to the work of the team.
- Problem Solving- Uses simple judgment and defined procedures in straightforward situations.
- Nature of Impact- Direct impact through the accuracy of the tasks performed.
- Area of Impact- Primarily on closely related work teams.
- Interpersonal Skills- Information exchange requiring tact and diplomacy is a significant feature of the job.
- Leadership- This job has no supervisory responsibilities.
- Functional Knowledge- Knowledge of activities in own job; focus on physical skills gained through training or experience.
- Project Management- Project/program team member.
Required Experience:
IC
Key Skills
- Senior Care
- Customer Service
- Developmental Disabilities Experience
- Computer Skills
- Microsoft Outlook
- Case Management
- Computer Literacy
- Dispatching
- Home Care
- Administrative Experience
- Social Work
- Word Processing
About Company
Welcome to Qlarant, bringing together the powerful resources of Delmarva Foundation, Health Integrity, Quality Health Strategies and Quality Health Foundation into a single source — to provide you with the Best People. Best Solutions. Best Results.®
