1+ months

Resolutions Specialist - Medicare - Bilingual - (125165)

Universal Health Services
McAllen, TX 78501
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  • Job Code
    125165

Job Summary: The Resolution Specialist acts as a liaison between members, providers, claims, enrollment, pharmacy and customer service departments. The Resolution Specialist supports the Manager of Operations and other departments to ensure accuracy, quality, and integrity services is being delivered to our members. Responsibilities will also include ensuring high performance levels for department, resolve escalated issues, assigned special projects, developing quality, compliance tracking tools, modifying processes, policies and procedures to achieve and maintain consistent compliance with Federal, State, and accrediting regulations and standards.

Job Requirements

Regulatory Requirements:

  • Knowledge of various computer systems including all Microsoft Office systems, Outlook, and budgetary.

  • Strong processes improvement skills necessary to get things done
  • Knowledge of Medicare Advantage & HMO contracts

  • Excellent verbal and written communication skills as well as public speaking and training abilities and experience.

  • Previous experience reviewing and analyzing statistical data to identify trends as well as potential problems/opportunities for improved service quality.

  • Knowledge of State and Federal regulations as they pertain to the health insurance industry.

  • Experience with Medicare Advantage, HMO, PPO, and self-funded products
  • Experience with STAR ratings, care cap reports and risk scores
  • High school diploma or equivalent.
  • Associates degree or equivalent work experience
  • Minimum 3 years related experience health plan experience, in claims or customer service, 3-5 years preferred

Language Skills:

  • Ability to effectively communicate in English and Spanish, both verbally and in writing.

Skills:

  • Excellent verbal and written communication skills as well as analytical and critical thinking skills with the ability to design, track and work towards specific measurable performance targets.
  • Must be able to deal with challenging customer situations in a professional manner. Ability to interpret and apply established policies and procedures.

  • Excellent computer skills which must include working knowledge of Microsoft Office Suite with emphasis on Excel and Power Point.

  • Must be a team player and have the ability to work independently with little supervision

  • Ability to manage multiple and divergent priorities and deadlines, work independently and pro-actively negotiate and manage expectations for mutually acceptable solutions and creatively problem-solve effective customer solutions.

  • Ability to effectively communicate in English and Spanish, both verbally and in writing.
Posted: 2020-02-20 Expires: 2020-04-02

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Resolutions Specialist - Medicare - Bilingual - (125165)

Universal Health Services
McAllen, TX 78501

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