RELI Group, Inc. Hiring for Complaint Reviewer at Remote Full Time

Responsibilities:

• Perform reviews of complaints and correctly determine and enter complaint review results per the federal client’s Standard Operating Procedures and internal procedures
• Perform secondary or tertiary complaint reviews to ensure accuracy of submitted information
• Support and closely follow the program’s quality process and initiatives
• Review and incorporate feedback from Lead QA Coordinator, Program Manager, and client to improve accuracy and quality of work
• Accurately enter review results using a RELI provided computer, keyboard and/or mouse
• Follow all established processes and procedures
• Report problems to Program Manager with regard to unique record or process issues
• Complete training as per federal client and organizational requirements
• Maintain security and confidentiality of Protected Health Information (PHI) and Personally Identifiable Information (PII)
• Consistently meet or exceed productivity and accuracy standards established by the client and/or the company
• Consistently meet attendance standards established by the company
• Interact appropriately with peers, co-workers, other Contractors, and the customer, when necessary. Contribute to building a positive team spirit
• Perform other duties and projects as assigned

Requirements:

• A minimum of two (2) years of experience in analyzing narrative information to make determinations/decisions
• Helpful work experience includes medical coding, medical billing, medical review, data entry, insurance, call center, helpdesk, criminal justice, education, or general office
• Familiarity with Health Insurance Marketplace (HealthCare.gov) is desirable
• Familiarity with or interest in reducing fraud, waste, and abuse of health care resources is desirable
• Ability to work independently and maintain an elevated level of concentration
• Capable of consistency, speed, and accuracy of task
• Ability to read, analyze, and interpret documentation
• Ability to communicate clearly and professionally with all levels of the organization, both written and verbal
• Ability to work well in a team environment, to collaborate with others, and interface with team members internal and external to the organization
• Establishes and maintains effective professional relationships with internal and external stakeholders
• Must be able to adapt to organizational change
• Must be proficient in Microsoft Office Suite
• Flexibility and ability to plan, prioritize, and execute multiple tasks in a fast-paced environment
• Self-motivated, well-organized, and detail oriented
• Ability to maintain a high level of confidentiality and integrity
• Must be authorized to work in the US
• CMS background investigation as required
• Minimum of HS Diploma/GED
• Bachelor’s Degree Preferred

EEO Employer:

RELI Group is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.

HUBZone:

RELI Group is an established SBA certified HUBZone and 8(a) small business. We encourage all candidates who live in a HUBZone to apply. You can check to see if you address is located in a HUBZone by accessing the SBA HUBZone Map.

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