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 according to 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 regulations.
- 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
- Experience in grievance and appeals processes.
- Degree in Healthcare or related field.
- Experience analyzing claims and differentiating between grievances, appeals, and organizational determinations.
- Basic computer skills, including PDF management and Excel navigation.
- Two years of health insurance experience and familiarity with state and federal 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.
