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 and providing comprehensive responses to cases, all while working in a fast-paced environment.
Responsibilities
- Process appeals and grievances, analyze, research, and provide comprehensive responses in accordance with established regulatory and accreditation guidelines
- Contact customers to gather information and communicate disposition of case
- Conduct pertinent research in order to evaluate, respond to, and finalize case
Requirements
- Experience handling a large load of work in a fast-paced environment
- Insurance, Medicare/CMS knowledge
- Customer Service Experience
- Writing Letters
- Analytical thinker
- Research Skills
- Multi-tasking abilities
- Familiarity with standard concepts, practices, and procedures for analyzing, interpreting data and contract and regulatory provisions
- Two (2) years customer service experience required
Nice-to-haves
- Grievance and Appeals experience
- Degree in Healthcare/computer skills
- Experience in analyzing a claim
- Experience in classification between a grievance/appeal/organizational determination
- Letter writing
- Basic computer skills
- Two (2) years health insurance experience and familiarity with health insurance state and federal regulations preferred
- Strong project management skills preferred
Benefits
- Health and dental benefits on the first day of employment
- Training opportunities
- Flexible/remote work options
- Growth opportunities
- 401K
- Competitive pay
