• Coordinated the intake of Member’s appeals and Provider’s disputes/grievances and Arizona Department of Insurance’s Complaints, by entering new cases into database, assigning new case numbers, and analyzing material provided by the members and providers.• Research and resolution of appeals, disputes, grievances and complaints; drafting and issuing of resolution letters, and communicate the resolution to interested parties. • Responsible for coordinating with the Claims, Network… Show more • Coordinated the intake of Member’s appeals and Provider’s disputes/grievances and Arizona Department of Insurance’s Complaints, by entering new cases into database, assigning new case numbers, and analyzing material provided by the members and providers.• Research and resolution of appeals, disputes, grievances and complaints; drafting and issuing of resolution letters, and communicate the resolution to interested parties. • Responsible for coordinating with the Claims, Network, Finance, Customer Care, Sales and any other Departments involved in the resolution of the cases, to ensure timely resolutions.• Cooperated with Medical Management to ensure timely medical review of appeals, disputes, grievances and complaints.• Assisted Manager with report creation, including tallying and categorizing appeals, disputes, grievances and complaints.• Coordinated heavy caseloads and ensure timely completion of cases within prescribed timelines.• Development of correspondence related to member appeals, provider grievances and Arizona Department of Insurance (ADOI).• Support as a customer care representative with regards appeals, grievances and complaints, attending to its originators by providing status and requesting further documentation/evidence if required. Show less

• Assistance in preparing and filing for all regulatory documentation (QHP).• Designer of work plan in order to comply with submission’s regulations and time frames.• Reviewer, tester and evaluator of submission’s preliminary and final data.• Assisting in preparing and distributing to all internal and external business partners a comprehensive product catalog containing all plan data including limitations, exclusions and URL links to supporting documents.• Reviewer of all plan… Show more • Assistance in preparing and filing for all regulatory documentation (QHP).• Designer of work plan in order to comply with submission’s regulations and time frames.• Reviewer, tester and evaluator of submission’s preliminary and final data.• Assisting in preparing and distributing to all internal and external business partners a comprehensive product catalog containing all plan data including limitations, exclusions and URL links to supporting documents.• Reviewer of all plan, rate and enrollment form information for a variety of externalonline sales vendors and internal marketing and sales materials.• Provider of ongoing support to all internal and external partners in understanding the Meritus plan and rate data. Show less

4 month contract position.

•Quality Engineer's Assistant, responsible for the coordination of Quality Assurance personnel in regards of load work, shifts, training, certifications and performance.•Internal Auditor for ISO-9000, ISOTS-16949, & ISO-14001, in charge of internal audits of documentation, process, materials and procedures; in order to obtain annual certification/re-certification of ISO standards.•Quality Documents Control, documentation and records keeper pertaining to client’s specifications… Show more •Quality Engineer's Assistant, responsible for the coordination of Quality Assurance personnel in regards of load work, shifts, training, certifications and performance.•Internal Auditor for ISO-9000, ISOTS-16949, & ISO-14001, in charge of internal audits of documentation, process, materials and procedures; in order to obtain annual certification/re-certification of ISO standards.•Quality Documents Control, documentation and records keeper pertaining to client’s specifications, revisions and changes; distribution and understanding.•Customer complaints/rejects assistance, in charge of receiving clients and vendor’s specifications, changes and revisions; also in charge of its distribution, comprehension and implementation. Responsible for the investigation and solution of customer/vendor’s rejects and complaints, as well as managing the implementation and follow-up of non-conformances, work plans and improvement opportunity. Show less

•Quality Control Manager's assistant, responsible for the coordination of Quality Assurance personnel in regards of load work, shifts, training, certifications and performance.•Quality Assurance Auditor's supervisor, in charge of audit finish goods and process according to clients and internal procedure’s specifications.•Internal Auditor for QSP/ ISO-9000-TS16949, in charge of internal audits of documentation, process, materials and procedures; in order to obtain annual… Show more •Quality Control Manager's assistant, responsible for the coordination of Quality Assurance personnel in regards of load work, shifts, training, certifications and performance.•Quality Assurance Auditor's supervisor, in charge of audit finish goods and process according to clients and internal procedure’s specifications.•Internal Auditor for QSP/ ISO-9000-TS16949, in charge of internal audits of documentation, process, materials and procedures; in order to obtain annual certification/re-certification of ISO standards. Show less