Research Specialist

Job Summary

To handle appeals and reconsiderations, customer service mail correspondence, internal email inquiries, and route complaints received to Professional Relations. Maintains all reporting to ensure compliance.

• Completes all appeals within a thirty (calendar) day turnaround time; maintains appeals log.
• Completes all reconsiderations within a seven (business) day turnaround time; maintains reconsideration log.
• Completes all customer service mail correspondence within a five (business) day turnaround time. This includes, but is not limited to, Claim Status Inquiries, Refund Disputes, and Insurance Verifications.
• Responds to all internal AR Research emails within a three (business) day turnaround time. This includes letter requests, claim status inquiries, etc.
• Receives all provider complaints and requests necessary documentation from provider and sends acknowledgement letter to the complainant. Routes all documentation received to Professional Relations to proceed with the complaint.
• Stays abreast of benefit changes, new enrollments and group terminations as provided by manager. Remaining familiar with available resources of information to resolve problems and answer questions.
• Prepares monthly and quarterly reports to be provided to Operations Admin Assistant the first of each month.

Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.

Will accept any suitable combination of education, training or experience. Position requires a high school diploma or GED plus 2 years insurance operations experience. Position also requires the ability to understand and apply state regulatory guidelines to the dispute process and the ability to remain familiar with available sources of information to resolve problems and answer questions and advanced experience working with spreadsheet software and intermediate experience working with alphanumeric data entry and word processing and basic experience working with 10-key and database.