Job Description

Location: Remote (Must reside within 2 hours distance of San Diego, CA)

Description:

• Also the following must be considered before sending the resumes over:

• Must be within 2 hrs from San Diego

• Willing to work Overtime and weekend

• No future planned time off

• Work schedule must be 8AM – 5PM, and no exception hours will be considered

  Bachelor’s degree is not required, however manager want to call out that the CW will not be eligible for future FTE positions. Highlighted below the keywords of resume’s will be considering for an interview:

• Healthcare Insurance Experience

• Healthcare Billing Experience

• Grievance/Appeals in healthcare setting

• Case management in healthcare setting

• Epic experience is a big plus

• Oracle experience is a big plus

• Healthcare Exchange experience

• Excellent research and analysis skills

• Excellent documentation skills

• Remote Options (Fully Remote, Partially Remote, KP Onsite): Fully Remote

• If Remote:

• o Will the worker need to be Remote local to the office or Remote anywhere in the US: Worker must live within a 2 hour driving distance to CSC San Diego.

• Required Level of Education and Preferred Level of Education: Bachelor’s / College Degree

• How many years of related experience are you looking for in your ideal candidate? At least 3 years working experience

• Specific Systems Knowledge Required: Microsoft Office Suite, Intermediate Excel, Training will be provided on systems.

• Expected Shift: 8am-5pm or 7am-4pm (depending on business requirements)

• Interview Process: Remote Video Conference (Camera On), Manager will coordinate and provide Meeting Invite.

  Top Daily Responsibilities:

• 1. Focuses on case resolution with emphasis of coverage issues to ensure no discrepancies exist among systems, with our members’ complaints.

• 2. Supports daily Business Case Development through timely analysis and resolution of member complaints by performing research and review through multiple systems.

• 3. Perform / timely follow up through member cases.

• 4. Ability to communicate with members when required.

  Top (3) Required Skills Candidate Should Have:

• Analytical skills – a must, in order to perform accurately and timely on cases, to ensure a first time full resolution is achieved.

• Must be able to proactively work in a collaborative Team Environment, demonstrating development of positive relationships with peers.

• Great communication skills to timely provide feedback on issues that might affect multiple members.

• Flexibility to adapt to and to follow ongoing process changes.

  Additional Skills Preferred (Not Required)

• Excel Intermediate 80% Pass (Online Test provided by supplier)

• Typing Skills: 30+ WPM (Online Test provided and verified by supplier)
  • **Only those lawfully authorized to work in the designated country associated with the position will be considered.**
  • **Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements.**

Benefits:

For information and details on employment benefits offered with this position, please visit . Should you have any questions/concerns, please contact our HR Department via our secure .

California Pay Equity:

For information and details on pay equity laws in California, please visit the State of California Department of Industrial Relations' website .

Rose International is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender (expression or identity), national origin, arrest and conviction records, disability, veteran status or any other characteristic protected by law. Positions located in San Francisco and Los Angeles, California will be administered in accordance with their respective Fair Chance Ordinances.

If you need assistance in completing this application, or during any phase of the application, interview, hiring, or employment process, whether due to a disability or otherwise, .

Rose International has an official agreement (ID #132522), effective June 30, 2008, with the U.S. Department of Homeland Security, U.S. Citizenship and Immigration Services, Employment Verification Program (E-Verify). (Posting required by OCGA 13/10-91.).

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