United States onlyWe are seeking a Grievance & Appeals Coordinator to analyze and resolve claims and authorization appeals from providers and pursue resolution of formal grievances from members.
Requirements
- Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.
- Gather, analyze and report verbal and written member and provider complaints, grievances and appeals
- Prepare response letters for member and provider complaints, grievances and appeals
- Maintain files on individual appeals and grievances
- May coordinate the Grievance and Appeals Committee
- Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information
- Assist with HEDIS production functions including data entry, calls to provider’s offices, and claims research.
- Manage large volumes of documents including copying, faxing and scanning incoming mail
- Performs other duties as assigned.
- Complies with all policies and standards.
Benefits
- Competitive pay
- Health insurance
- 401K
- Stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- Flexible approach to work
