Experience handling a large load of work in a fast-paced environment
Insurance, Medicare/CMS knowledge
Customer Service Experience
Grievance and Appeals experience
Requirements:
Processing appeals, grievances, complaints, and inquiries received from members, authorized representatives, and regulatory agencies.
Analyze the customer’s concerns, conduct necessary research to make appropriate and accurate case decisions.
Keep an accurate documentation record that details steps and actions taken to resolve the customer’s concerns.
Communicate the outcome and resolution of all appeals, grievances, complaints, and inquiries via written correspondence to the customer.
Job description
Our client, a Health Insurance organization, is looking for a Grievance & Appeals Coordinator to work remotely.
Responsibilities
Processing appeals, grievances, complaints, and inquiries received from members, authorized representatives, and regulatory agencies.
Analyze the customer’s concerns, conduct necessary research by leveraging various internal and external resources and contacts in order to make appropriate and accurate case decisions.
Keep an accurate documentation record that details steps and action taken to resolve the customer’s concerns. The outcome and resolution of all appeals, grievances, complaints, and inquiries is communicated via written correspondence to the customer using clear and simple language and include elements that satisfy corporate, regulatory, and accreditation timeframes, accuracy and response guidelines.
Requirements:
Experience handling a large load of work in a fast-paced environment
Insurance, Medicare/CMS knowledge
Customer Service Experience
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 (how to save a PDF, how to navigate excel, learning new systems)
