The incumbent will help guide their team, ensuring they can successfully gather facts, documents, apply sound decision making through the investigation, and send clear, accurate, grammatically correct member and provider facing letters, detailing the outcome of the investigation or appeal with the highest degree of quality within the timelines as required. For those assisting with member complains requires our team members to exercise their critical thinking, retrace a member's journey, coordinate with internal and external parties in the goal of making our member whole, and improving their circumstances.