California Customer Support Specialist

Job Summary

Supporting the Appeals and Grievances team, the remote Customer Support Specialist will learn to resolve member and provider complaints, investigate administrative issues, and escalate complex cases while adhering to regulatory standards, with a focus on positive outcomes for members.

Key responsibilities

• Learn and resolve less complex appeals and grievances cases to ensure positive member outcomes
• Investigate and resolve administrative complaints while adhering to CMS and state regulatory standards
• Intake, prepare case files, and route complaints to appropriate departments for resolution

Required qualifications

• High School diploma or equivalent; Associate's degree preferred
• 1+ years of experience in Managed Care with Medicare, Medi-Cal, or State Sponsored programs
• Experience interpreting and applying regulations under firm deadlines
• Proficient in MS Office applications, including Word, Outlook, and Excel
• Knowledge of medical terminology and regulatory guidelines (DHCS, NCQA, CMS, DMHC) preferred