• Communicates, both in writing and verbally in response to inquiries/complaints filed with the Department of Insurance and Better Business Bureau and uses necessary means to provide information• Research and evaluate consumer needs with limited supervision • Facilitate timely closure of consumer complaints and performs follow up activities to ensure resolution • Ensures compliance with company procedures and state insurance laws; discuss violations with the Assistant Group… Show more • Communicates, both in writing and verbally in response to inquiries/complaints filed with the Department of Insurance and Better Business Bureau and uses necessary means to provide information• Research and evaluate consumer needs with limited supervision • Facilitate timely closure of consumer complaints and performs follow up activities to ensure resolution • Ensures compliance with company procedures and state insurance laws; discuss violations with the Assistant Group Counsel; participate in regular meetings to discuss complaint trends• Accurately notes inquiries/complaints in the designated logs and system, and records all actions taken• Review escalated claims; apply policy provisions and company procedures to determine if claim is payable• Consult with managers, directors, and vice-presidents regarding unusual delays in processing of claims, billing, policy documents• Maintain records, files, and documentation as appropriate Show less

Assist with inbound telephone and written prior authorization requests.Subject Matter Expert to new employees; provide training on all client benefit plans.Oversee tracking, trending, and reporting of prior authorization and service quality metrics