Research Specialist Lead

This is a fully remote position, open to applicants in United States.

📋 Description

• Investigate and resolve intricate and escalated member concerns.

• Guarantee precise, prompt, and compliant outcomes.

• Offer subject matter expertise in research decisions, documentation, and written communications.

• Foster quality and consistency in case management.

• Review and authenticate case documentation and correspondence.

• Evaluate cases for escalation, reclassification, or further review.

• Initiate necessary actions to ensure swift resolution.

• Contribute to reporting, tracking, and documentation that supports adherence to service levels and performance monitoring.

• Identify and facilitate improvements in processes, workflows, and quality.

• Carry out other assigned duties.

⛳️ Requirements

• High School diploma from an accredited institution or equivalent GED.

• Four years of experience in customer service, benefit plans, grievances, or appeals.

• Must be eligible to work in the United States without requiring a work visa or residency sponsorship.

• Ability to be self-driven and work with minimal oversight.

• Strong organizational, analytical, interpretive, problem-solving, and time management abilities.

• Excellent interpersonal communication skills, including conflict resolution and active listening.

• Capability to work under tight deadlines while effectively managing multiple priorities.

• Ability to optimize interdepartmental and client resources.

• Preferred: Two years of experience in escalation resolution.

• Preferred: Experience in drafting professional correspondence.

• Preferred: Previous experience in healthcare and/or Government Programs (Medicare/Medicaid).

• Must comprehend, adhere to, and attest to job-specific security responsibilities and controls.

• Must comply with relevant legal, regulatory, contractual, and internal policy requirements.

• Must be capable of performing the essential functions of the position.

🏝️ Benefits

• Benefits, incentives, and additional compensation are available; refer to the Benefits at a glance page.

• Reasonable accommodations for employees with disabilities.

• Equal opportunity and affirmative action employment.

• Tobacco-Free Workplace.