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Years of Experience
Date Last Verified
Resolution Specialist Duties: Identifying, managing, and responding to customers’ needs by providing product information and resolving problems with accuracy and efficiency. Candidates must have a track record of excellent verbal and written communication skills since customer interaction is primarily via email and phone calls. Participate in developing, implementing, and improving department procedures. Coordinate and communicate with Claims Resolutions Managers and Senior Resolution & Appeals Specialist, as required, to respond to inquiries. Manage incoming calls and provider inquiries; identify and assess callers’ needs to achieve customer satisfaction. Copy, scan, store documents. Update proprietary database. Follow communication procedures, guidelines, and policies.
Qualification and Experience
Qualifications: Bachelor’s Degree or equivalent education or experience preferred. Strong job experience can be demonstrated. Paralegal certificate or other business-related certificate (optional). 3-5 years in customer support or client services. 3-5 years' writing business correspondence (emails and letters). Familiarity with health industry, medical terminology, or coding helpful but not required. Strong phone / active listening skills. Excellent communication skills—both written and verbal. Advanced computer skills, especially MS OFFICE, WORD and EXCEL. Strong organizational and analytical skills; ability to work with minimal supervision. Ability to multi-task, prioritize work, and manage time efficiently and effectively. Strong organizational and time management skills, along with an attention to detail and the ability to multi-task. Knowledgeable of the processes and procedures of the Resolution & Appeals Department and will learn all aspects of the department. Excellent organizational and time-management skills; ability to multi-task and work with minimal supervision. Strong written and verbal communication skills; composing internal and external email correspondence. Attention to details and problem solving skills.
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