JOB REQUIREMENTS: Appeals Specialist Job Locations US-WI-Madison ID 2024-2092 Category Legal & Compliance Type Regular Full-Time Overview Quartz is seeking an Appeals Specialist to join our Legal & Compliance Team. This position will play a pivotal role in ensuring fair and accurate resolution of appeals and upholding the high standards of our organization\'s dedication to exceptional customer service. The Appeals Specialist position will facilitate, coordinate, and proactively investigate member appeals, grievances, and regulatory inquiries. Using their problem-solving skills, this position will create a comprehensive case file based on a thorough investigation of oftentimes, complex member concerns. This role will also evaluate various resolution options and exercise independent judgement to determine the best course of action while maintaining excellent customer service relations through courteous communication and accurate handling of member issues. Benefits: Collaborate with leadership to manage resources Full-time virtual, work from home environment available Starting pay range: \$23/hr. - \$27/hr. plus robust benefits package Responsibilities Identify and conduct thorough investigations of complex member disputes to prepare complete case files and respond to regulatory inquiries. Communicate all necessary verbal and written communications related to the decision of an appeal including but not limited to: members, providers, legal entities, etc. within regulatory timeframes. Schedule, coordinate, and facilitate meetings with the review committee, the member, and any other ad hoc representatives. Respond to customer inquiries, in a courteous and efficient manner regarding eligibility, verification of benefits and claims payment status via telephone or in person, on an as available/needed basis. Investigate customer written inquiries and coordinate with proper internal departments to ensure timely responses are completed. Investigate, coordinate, and reply to all written complaints and other regulatory inquires received by the company ensuring that handling of grievances, appeals, and regulatory inquiries comply with applicable state and federal statutes, regulations, and sub-regulatory guidance. Develop health plan training programs and conducts training for health plan staff relating to: identifying complaints/grievances/appeals; appropriate documentation and reporting such as disputes; government requirements involving the dispute resolution process and health plan policies and procedures for the various dispute resolution processes. Qualifications High School diploma or equivalent 1 year of experience working for Quartz\'s customer relations teams (customer success, claims, enrollment, etc.) OR 3+ years of intensive customer service experience, preferably... For full info follow application link. Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individual with Disabilities ***** APPLICATION INSTRUCTIONS: Apply Online: ipc.us/t/82005D4A08F9469E