OpTech - Detroit, MI
posted 24 days ago
Full-time - Entry Level
Hybrid - Detroit, MI
Religious, Grantmaking, Civic, Professional, and Similar Organizations
About the position
The Grievance & Appeals Coordinator at OpTech is responsible for processing appeals and grievances, ensuring compliance with regulatory and accreditation guidelines. This role involves engaging with customers to gather necessary information, conducting research to evaluate cases, and providing comprehensive responses. The position is designed for individuals who thrive in fast-paced environments and possess strong analytical and customer service skills.
Responsibilities
- Process appeals and grievances in accordance with established regulatory and accreditation guidelines.
- Contact customers to gather information and communicate the disposition of cases.
- Conduct research to evaluate, respond to, and finalize cases.
Requirements
- Experience handling a large workload in a fast-paced environment.
- Knowledge of Insurance, Medicare/CMS.
- Customer service experience of at least two years.
- Strong writing skills for letter writing.
- Analytical thinking and research skills.
- Ability to multi-task and manage time effectively.
- Familiarity with standard concepts and practices for analyzing and interpreting data.
Nice-to-haves
- Grievance and Appeals experience.
- Degree in Healthcare or related field.
- Experience in analyzing claims.
- Experience in distinguishing between grievance, appeal, and organizational determination.
- Basic computer skills, including saving PDFs and navigating Excel.
- Two years of health insurance experience and familiarity with health insurance regulations.
- Strong project management skills.
Benefits
- Health and dental benefits from the first day of employment.
- Training opportunities.
- Flexible/remote work options.
- Growth opportunities.
- 401K plan.
- Competitive pay.
