Grievance & Appeals Coordinator

ICONMA - Troy, MI

Full-time

Remote - Troy, MI

Professional, Scientific, and Technical Services

About the position

The Grievance and Appeals (G&A) Coordinator is responsible for processing appeals, grievances, complaints, and inquiries from members, authorized representatives, and regulatory agencies. This role involves analyzing customer concerns, conducting research, and making informed case decisions. The Coordinator will facilitate managerial level conferences and maintain accurate documentation of the resolution process, ensuring compliance with corporate and regulatory guidelines.

Responsibilities

• Process appeals, grievances, complaints, and inquiries from members and regulatory agencies.
• Analyze customer concerns and conduct necessary research to make informed case decisions.
• Coordinate and facilitate managerial level conferences with customers and their representatives.
• Maintain accurate documentation of steps and actions taken to resolve customer concerns.
• Communicate outcomes and resolutions via written correspondence in clear and simple language.
• Stay updated on products, networks, internal policies, and regulations for accurate resolution of cases.

Requirements

• Excellent written and verbal communication skills, including proficiency in proofreading and grammar.
• Analytical mindset with the ability to examine facts and make informed decisions.
• Strong PC application and system skills to navigate multiple databases.
• Ability to apply policies and procedures to arrive at accurate conclusions.
• Ability to analyze, interpret, and conduct research for thorough responses.
• Ability to work in a fast-paced environment with tight deadlines.
• Problem-solving aptitude with strong attention to detail.
• Ability to prioritize responsibilities and manage time effectively.
• Ability to work collaboratively with management and team members.
• High regard for confidentiality of sensitive information.
• Previous customer service or concierge experience.

Nice-to-haves

• Previous health care or health insurance industry experience.