Customer Service Representative

Appeals and Grievance Coordinator for Sagility's member and provider complaints, grievances, and appeals, serving as the primary investigator and point of contact to research, resolve, and respond in compliance with state and federal requirements. Responsibilities include acknowledging grievances/appeals, educating members/providers about the process, gathering relevant information, determining appropriate resolution, notifying involved parties, conducting unbiased and timely investigations, documenting actions, and ensuring processing adheres to regulations. Skilled in healthcare domain processes, regulatory compliance, investigation and documentation, stakeholder communication, and delivering accurate resolutions.