Customer Service Specialist - Medicare Integrity

@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.
Are you looking for an opportunity to combine your excellent Customer Service, communication and research skills with your knowledge of healthcare? Do you approach your work with a strong sense of urgency and thrive in fast-paced environments? If this describes you, this could be the perfect career opportunity! As a member of an Investigations Medicare Integrity Contract team, the Customer Service Specialist performs clerical/administrative duties related to reports of potential fraud, waste and abuse from Medicare Part C&D beneficiaries.
Essential Duties and Responsibilities:

• Communicates with beneficiaries, plans, pharmacies, and providers as needed to resolve complaints.
• Provides information to investigative and medical staff.
• Evaluates the facts of a complaint and researches additional information as necessary.
• Compiles findings and determines if appropriate for presentation to triage team.
• Assists in preparing weekly and monthly reports of all Customer Service activities.
• Handling a wide variety of complex and confidential situations.
• Performs data entry of complaints into the case management system and a variety of other databases.
• Performs background research on subjects of interest as required for the screening of complaints for triage.
• Drafts and writes correspondence using appropriate letter templates or revises the content based on the facts presented in the complaint.
• May communicate with external customers including beneficiary or individual complainants, representatives from the Senior Medicare Patrol, Plan Sponsors, CMS and others.

Required Experience:

• High school diploma or general education degree (GED) required with at least one year related experience and/or training, Customer Service/call center and/or Medicare knowledge preferred; or equivalent combination of education and experience.
• Healthcare or insurance backgrounds strongly preferred.
• Medical terminology and coding background is plus.
• Working knowledge of Microsoft Office is required.
• Must be able to work effectively in a fast-paced environment with high volume and able to shift gears rapidly as needed.

Established in 2010, @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.