Associate-Back Office-Customer Service

Handle complex healthcare cases such as claims rework, provider appeals, and documentation analysis with minimal supervision. Retrieve supporting documents from various systems, create appropriate case files, and ensure accurate attachment and classification. Analyze each case to determine resolution or escalation to Subject Matter Experts (SMEs). Implement SME guidance to complete case processing effectively and accurately. Generate customer communication letters and ensure timely dispatch as per process requirements. Conduct root cause analysis for rework and escalations; recommend corrective and preventive actions.