Benefit Resolution Facilitator

Costa Mesa, CA | Full time

Job ID: [SA] Bennefit Resolution Facilitator Industry: Insurance Pay Rate: $15.00

The Resolution Facilitator will research and generate written responses to patient and provider correspondences pertaining to eligibility, claims, refund requests, returned mail, and all general inquiries. You will prepare and present appeal cases to the Administrative Review Committee and grievances to the Client Relations Review Committee. 

Formulate patient survey results, submit non elective contact lens requests for medical review, and maintain production logs.

Provides support to the Benefit Resolutions Team Leader and other department staff.

Work well in a team environment- we are a very team oriented organization and work towards a common goal - You have to like pitching in whenever help is needed!


Day to Day Job functions:

Conveys kindness and compassion to patients, providers, groups, brokers, and any other internal or external co workers and customers.

Courteously addresses all customer concerns through written and verbal communications.

Have the willingness to adapt, with a positive attitude, to changes in processes, responsibilities and assignments.

Assists internal and external customers by effectively demonstrating the Company’s established service standards.

Generates acknowledgement letters within 5 calendar days of receipt for appeals and grievances.

Responds to all general correspondence within 10 business days.

Respond to appeals and grievances within 21 calendar days, never to exceed 30 calendar days.

Prepares requests for non elective contact lenses for clinical review, forwards to Medical

Director(s), and generates determination letters within 5 business days. Maintains all records and submits related claims when applicable.

Formulates, researches, and prepares patient survey results.

Maintains Excel production logs with accurate dates and data, and updates them daily.

Microsoft Word, Excel and Type 45 WPM (We will ask for assessment results)


High School Diploma or Equivalent

Medical Insurance experience


We have great opportunities for high quality people like yourself. Tell your friends, relatives and acquaintances. We appreciate your referrals and you have an opportunity to earn $50.00 per referral.

We will consider for employment all qualified Applicants, including those with Criminal Histories, in a manner consistent with the requirements of applicable state and local laws, including the California Fair Employment and Housing Act (FEHA).


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