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Escalations Specialist
JOB SUMMARYThe Escalations Specialist investigates, evaluates and resolves member and provider issues or complaints for Commercial, Medicaid, Medicare and Marketplace products. Responsibilities include, but are not limited to: timely classification and resolution of cases, review, research and root cause research. Also includes coordination and interaction with other health plan departments for issue resolution. The Specialist is also accountable for member and provider manual updates, communication, education and training, and providing feedback for the internal knowledge-based tool.ESSENTIAL FUNCTIONS OF THE ROLEExamines and evaluates documentation to assess member/provider issues/complaints. Conducts research and ro


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