Triage Specialist

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Job description

MAG Triage Specialist Job Description Bring your drive for excellence, team orientation and customer commitment to Independence; help us renew and reimagine our business and shape the future of health care. Our organization is looking to diversify, grow, innovate and serve, and we are looking for committed, empowered learning-oriented people to join our team. If this describes you, we want to speak with you. The Medicare Triage Specialist investigates Medicare Advantage member appeals and grievances in accordance with established policies and CMS regulations. Duties include, but are not limited to: Reviews all incoming potential appeals and grievances, through the various channels and multiple lines of business, to determine the next steps towards resolution. Extensively researches all of the internal systems to ensure there is a full understanding of the reason for the request and makes the initial decision on the pathway that the request will follow. Identifies all related documentation (internal and external review is needed) to support the disposition review and includes the information in the case file. Identify and document misroutes and other invalid requests to notify the initiating area of the invalid request in an effort to mitigate ongoing issues. Identify all circumstances that would result in cases needing to be handled/reviewed expeditiously. Does outreach for additional information, consent, and acknowledgement, which may include building and sending letters to members and/or providers. Compiles all necessary information including documentation, creates the case in the Appeals system, document and close the request. Well qualified applicants will possess an associate degree and/or three years related experience with customer service and/or complaints handling. A working knowledge of Medicare and Medicare Supplemental products is also preferred. In addition, the qualified applicant would demonstrate their ability to handle complex member issues, exceptional writing, editing and proofreading skills, excellent customer service, organizational, verbal, and written communication skills. A working knowledge of Word and Excel is a plus. Time management skills required. Able to work on a weekend rotation.

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