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Form of workQlarant is 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. Qlarant 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, Qlarant has the perfect career opportunity! As a member of our Investigations MEDIC team, the Customer Service Specialist performs clerical/administrative duties related to reports of potential fraud, waste and abuse from Medicare Part C&D beneficiaries.
Please Read Carefully:
- The starting rate is $19/hour (non-negotiable).
- Qlarant's associates receive an excellent benefits package that includes health, dental, vision, short-term and long-term disability, generous sick, vacation and holiday leave, and two retirement plans. We also offer a collaborative and inclusive work environment.
- The preferred location for this position is our Easton Maryland headquarters. Once you've successfully completed training (8-12 weeks), you would be eligible to work a hybrid schedule that requires only 2 days in the office each week.
- Well qualified candidates living in Maryland or Delaware 40 miles or more from our office located at 28464 Marlboro Avenue, Easton, MD 21601, are eligible to be home-based. We cannot make exceptions to the Maryland/Delaware and 40 mile requirements.
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.
