Collabera Operations Specialist in Mason, Ohio
Collabera is looking to fill a Operation Specialist opportunity with one of our clients in Mason, OH
Work Location Cincinnati service centre 4000 Mason, OH 45040
Job Title Operation Specialist
Duration 6 months (with high possibility of extension)
The QA Ops Specialist leads the resolution of member and provider complaints and appeals related to quality of care, access to care and benefit determination.
•Work collaboratively with other departments including customer care, claims, and legal to investigate and resolve member complaints and appeals.
•Develops formal request and response letters and written summaries of cases including the facts of the case, resolution, and directions regarding provider education or actions.
•Provides monthly, quarterly and annual reporting to QA committee and clients regarding complaints and appeals to ensure compliance with performance guarantees.
•High School Diploma/GED
•2+ years claims processing or vision benefits and product experience
•Bachelor’s degree in Business related disciplines