Job Description : Analyze, investigate, and resolve appeals, complaints, and grievances. Provide comprehensive and thorough responses in compliance with CMS guidelines, state and federal regulations, and accreditations standards. Interact with internal and external customers and subject matter experts to gather information, build a case, and make decision to maintain or reverse appeal or grievance. Analyze and interpret systems data, contract language, regulatory provisions, and apply to casework. Adhere to policies, procedures, and audit standards to remain compliant and audit ready Candidates should have the following skills and attributes: * excellent verbal and written communication skills. * have strong letter writing and proofreading skills. * strong PC application and system skills- having the ability to navigate multiple computer systems and databases. * be analytical, having the ability to examine a matter, the facts, contextual information and make an informed decision or implement and execute a reasonable, rational resolution. * have the ability to work with a sense of urgency * have high attention to detail and remain organized * have high regard for quality work, accuracy, and confidentiality * have previous customer service experience and excel at customer servicing . * have the ability to use and apply previous experiences and knowledge when encountering new or unfamiliar situations * professional in conduct * ability to work independently or with minimal oversight * ability to work in a fast paced environment with tight deadlines and high quality standards * ability to work well under stressful circumstances Company Description W3R Consulting is a Southfield, Michigan based staffing and consulting firm that provides talent, technology consulting and advanced analytics solutions to Fortune 500 companies in the automotive, financial, healthcare, insurance, professional and business services, and retail industries. In 2012, w3r acquired Nurse Now Staffing. inner of numerous customer and industry awards, this year W3R celebrates 22 years of innovation, exceptional customer service and community engagement.
W3R Consulting is a Southfield, Michigan based staffing and consulting firm that provides talent, technology consulting and advanced analytics solutions to Fortune 500 companies in the automotive, financial, healthcare, insurance, professional and business services, and retail industries. In 2012, w3r acquired Nurse Now Staffing. inner of numerous customer and industry awards, this year W3R celebrates 22 years of innovation, exceptional customer service and community engagement.