Job Opportunity At Qlarant Qlarant is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Qlarant is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In addition, our Foundation provides grant opportunities to those with programs for underserved communities. Best People, Best Solutions, Best Results
Job Summary:
Receives complaints from a variety of sources. Interviews complainants or beneficiaries concerning the Medicare Advantage or Prescription Drug Programs to determine disposition of case. Researches subjects and beneficiaries of received complaints.
Essential Functions:- Communicates with beneficiaries, plans, pharmacies, and providers as needed to resolve complaints.
- Evaluates the facts of a complaint and researches additional information as necessary.
- Compiles findings and determines if appropriate for closure or presentation to Level II team.
- Handles a wide variety of confidential situations.
- Performs data entry of complaints into the case management system and a variety of other databases.
- Performs minor background research on subjects of interest as required for the screening of complaints.
- Prepares appropriate letter templates and/or revises the content based on the facts presented in the complaint.
- Communicates with external customers including beneficiary or individual complainants, representatives from the Senior Medicare Patrol, Plan Sponsors, CMS, and others.
- Level of Supervision Received: Under close supervision, works closely with manager to prioritize efforts
- Education (can be substituted for experience): Minimum High School Diploma or GED required
- Work Experience (can be substituted for education): 0 - 2 years of experience required; 2 - 4 years preferred Call Center experience preferred Data Entry experience preferred Healthcare or Medicare experience preferred
Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities. Qlarant is a drug-free workplace. All offers of employment are contingent upon successful completion of pre-employment background and drug screens.
