Responsible for providing oversight for the development and maintenance of training programs within the department. Primary duties may include, but are not limited to:· Oversees and assists associates responsible for resolving and monitoring Medicare Complaints, Appeals and Grievances. Participates in the delivery of coaching and feedback.· Performs quality control functions, including the timely and accurate completion of required audits.· Responds to inquiries and system changes.· Identifies, investigates, and resolves audit processing issues, and provides oversight and assistance with procedure guidelines.· Resolves Rebuttal Issues for the Quality Auditors.· Develops and delivers training to staff as needed.· Provides ongoing feedback to the manager regarding the performance of the Quality Auditors.

• Review grievance cases to determine compliance with federal and state regulations, enterprise policies and procedures and all related accreditation standards.• Review case documentation to assess appropriate system entries have been made and that the step-by-step process is sufficient to mitigate risk associated with regulatory reviews, accreditation reviews, and potential litigation.• Prepare audit findings and recommendations for G&A associates and leadership on a weekly basis.• Assist leadership in process improvement strategies to achieve business objectives.• Identify and communicate error trends and suggest corrective procedures.• Review and approve letters for MMP and NJ DSNP grievances.• Review and approve letters for analyst during their training period.

• Research and respond via telephone, e-mail, and in writing to inquiries and complaints received from regulatory agencies in Connecticut, Maine and New Hampshire. • Research and respond to all Connecticut, Maine and New Hampshire member and provider complaints addressed to Anthem's CEO, Senior Executives and Plan Presidents.• Contact to the Connecticut Department of Insurance, Attorney General’s Office, Connecticut Congressional offices and the Connecticut Office of Health Care Advocates. • Provide expedient responses and updates to executive office.

• Respond to customer questions via telephone and email regarding insurance benefits, provider contracts, eligibility, claims, pharmacy and billing.• Analyze problems and research data to provide information/solutions. • Thoroughly document information, changes in the database and inquiry outcomes for accurate tracking and analysis.• Place follow-up telephone calls / e-mails to answer customer questions.

Provide superior telephonic sales and service for perspective members of Medicare VIP plans.Collaborate with Marketing, Sales, and Billing to ensure customer satisfaction.

• Communicating directly with clients, account executives, and senior managers to ensure customer satisfaction and increase revenue• Designed, wrote copy and implemented multi media advertising campaigns