Grievance and Appeals Specialist (Hybrid)

Village Care•New York, NY

1d•Hybrid

About The Position

VillageCare is looking for a self-motivated individual for a Full Time role as the Grievance & Appeals Specialist. This position ensures that grievances and appeals are resolved accurately and appropriately while advocating for members. The specialist will act independently and communicate with providers, physicians, and Plan's departments to investigate and resolve grievances and appeals.

Requirements

Associate's Degree in a related field
2-3 years of work experience in an Insurance Company, Workers Compensation, Disability, HMO or MLTC.
Knowledge of appeals and grievances, claims processing or utilization management/case management in a managed care organization required.
Proficient with general computer software including Microsoft Excel, Word and Outlook.
Must reside within the New York Tri-State Area - NY, NJ, or CT.

Responsibilities

Receive, process, categorize and perform initial research on Grievance & Appeals.
Correspond with members and document as required by regulations.
Accurately complete data entry and system documentation.
Compliance with all regulatory and departmental timelines.
Participate on projects and individual special assignments as needed.