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About the position
The Grievance and Appeals Coordinator is responsible for processing appeals and grievances, analyzing and researching cases, and providing comprehensive responses in line with regulatory and accreditation guidelines. This role involves direct communication with customers to gather necessary information and inform them of case outcomes, as well as conducting research to evaluate and finalize cases. The position requires familiarity with standard practices for data analysis and interpretation, particularly in the context of health insurance regulations.
Responsibilities
- Process appeals and grievances according to established guidelines.
- Analyze and research cases to provide comprehensive responses.
- Contact customers to gather information and communicate case dispositions.
- Conduct research to evaluate and finalize cases.
- Interpret data and apply contract and regulatory provisions.
Requirements
- High School Diploma or GED required.
- Two (2) years customer service experience required.
- Two (2) years health insurance experience preferred.
- Familiarity with health insurance state and federal regulations preferred.
Nice-to-haves
- Bachelor's Degree in English, Communications or related field preferred.
- Strong project management skills preferred.
- Grievance and Appeals experience preferred.
- Degree in Healthcare/computer skills preferred.
- Experience in analyzing a claim preferred.
