Customer Service Coordinator - Healthcare Fraud

Easton, MD

@Orchard LLC is retained by 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. Our Client 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 under-served communities.

A Customer Service Coordinator 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.

This is an onsite position, based in Easton, MD.

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

This is an hourly position with compensation in the $20.00-$20.10 per hour range, based on experience.

If you match the requirements for this opportunity and believe you have the experience and talent to succeed in the role, we need to hear from you!

Established in 2010, @Orchard LLC, also known as, Talent Orchard has an exceptional reputation, providing staffing solutions to time-sensitive, talent scarcity issues to deliver better talent management ROI.  Our specialty lies in the critical area of program talent acquisition and resource management, not in one narrow skillset, but across many areas of technical and functional delivery. To learn more about our other exciting opportunities, visit our Jobs Page at www.atOrchard.com.