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 information, conducting research, and providing comprehensive responses to cases. The position requires strong analytical and project management skills, as well as the ability to work in a fast-paced environment.
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.
- Analyze and interpret data related to grievances and appeals.
- Familiarize with standard concepts, practices, and procedures in the field.
Requirements
- High School Diploma or GED required.
- Two (2) years of customer service experience required.
- Two (2) years of health insurance experience preferred.
- Familiarity with health insurance state and federal regulations preferred.
- Strong project management skills preferred.
Nice-to-haves
- Bachelor's Degree in English, Communications, or a related field preferred.
- Grievance and Appeals experience preferred.
- Experience in analyzing a claim preferred.
- Experience in classification between a grievance, appeal, and organizational determination preferred.
Benefits
- Health and dental benefits from the first day of employment.
- Training opportunities.
- Flexible/remote work options.
- Growth opportunities.
- 401K and competitive pay.
