Medicare Grievance Specialist (Pharma Technicians)

Gratitude Inc

1660 Views

13 hours ago

1-3 Year(s)

₱ 35 - ₱ 40K p.m

Manila (Eastwood quezon city)

Job Description

Key Skills

Disputes Management Strong communication and interpersonal skills

1 candidate(s) have already applied for this Job. Apply now

Recommended Minimum Skills Requirements (MSRs):

Technical Skills:
• Proficiency in Microsoft Office Suite (Word, Excel, Outlook)

Soft Skills:
• Strong problem-solving and decision-making abilities
• Excellent verbal and written communication skills in English
• High level of empathy, patience, and active listening
Operational and Communication Skills:
• Ability to prioritize tasks and meet deadlines in a fast-paced environment
• Strong organizational and documentation skills
• Accuracy and attention to detail
• Ability to communicate effectively and convey complex information

KEY RESPONSIBILITIES:

Grievance Handling:
o Investigate and resolve member grievances related to Medicare Part D drug
coverage, claims, and pharmacy issues
o Ensure all grievances are resolved within required CMS timelines and documented
appropriately
Communication:
o Act as a liaison between members, providers, and pharmacies for Medicare
grievance resolution
o Provide clear and empathetic communication throughout the grievance process
Compliance:
o Adhere to all CMS (Centers for Medicare & Medicaid Services) guidelines and
company policies
o Maintain confidentiality of sensitive member information
Documentation:
o Accurately document all interactions and resolutions in the client system
o Prepare reports as required for compliance and auditing purposes
Collaboration:
o Work closely with other departments to investigate and resolve grievances
o Provide insights and feedback on recurring issues to improve processes
Recommended Minimum Skills Requirements (MSRs)

Role

Pharmacy

Timings

Night Shift (Permanent)

Industry

Health/Fitness/Wellness

Work Mode

Work from office

Functional Area

Medical Professional / Healthcare Practitioner / Technician

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