Coordinator, Appeals & Grievances

Evolent

82d • $22

About The Position

Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture.

Requirements

• A high school diploma or GED is required.
• Minimum of 3 years’ experience in an Appeals and Grievances role or comparable administrative role within a health plan, managed care organization or third-party administrator is required.
• Exceptional written communication skills, with the ability to draft clear, professional, and error free correspondence.
• Proficiency with CarePro and related health plan applications used for case processing is preferred.
• Familiarity with healthcare processes, benefit structures and regulatory guidelines (such as CMS and state requirements) sufficient to review case documentation and ensure correct handling.
• Excellent attention to detail with demonstrated ability to research issues, follow established workflows, and determine next steps.
• Highly organized with the ability to prioritize, multitask, and adapt in a fast-paced environment while maintaining accuracy.
• Demonstrated ability to research issues and determine next steps.
• Experience with Windows, Excel and related computer applications, with strong keyboarding and system navigation skills.

Responsibilities

• Review and process case requests including Consult P2Ps, BCBS TN Rad Onc IROs, Out of Network Benefit Denial packets, Overturns, and other special requests received via email, ensuring alignment with regulatory requirements, health plan guidelines and professional correspondence standards.
• Manage workload effectively by moving cases through the appropriate stages in CarePro and other internal systems to meet service level agreements (SLAs).
• Maintain accurate documentation and tracking in internal systems to support reporting, compliance and audits.
• Meet established department guidelines related to productivity, quality and timeliness.

Benefits

• Comprehensive health insurance benefits
• Bonus component dependent on pre-defined performance factors

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 1,001-5,000 employees