Grievance & Appeals Claims Specialist - Denver Health Medical Plan (Must Live in Colorado. Weekly On Site Requirement.)
About The Position
The Grievance & Appeals Claims Specialist handles and resolves client grievances and appeals related to services and claims. The role ensures complaints are addressed promptly and accurately while maintaining compliance with regulatory standards and organizational policies. The specialist advocates for clients, helps resolve issues and improve satisfaction, and safeguards organizational integrity and efficiency. This is a hybrid role based in Denver, Colorado. Applicants must live in Colorado and work in the office two days per week. The schedule is days, and the position is regular.
Requirements
- High school diploma or GED required.
- One of the following experience pathways is required: an associate degree and one year of claims, customer service, or grievance and appeals experience; three years of insurance industry experience; or one year of QNXT experience.
- Strong knowledge of regulatory requirements and insurance products.
- Excellent communication and interpersonal skills, including strong written and verbal communication.
- Proven analytical and problem-solving abilities.
- Ability to handle sensitive and confidential information appropriately.
- Proficiency with relevant software and database systems.
- Strong organizational and time-management skills.
- Understanding of grievance and appeals processes.
- Attention to detail and accuracy.
- Ability to work independently and as part of a team.
- Ability to manage multiple tasks and meet deadlines.
- Must live in Colorado.
Nice To Haves
- Associate degree preferred.
- Claims experience preferred.
Responsibilities
- Handle and resolve incoming grievances and appeals in a timely and efficient manner.
- Accurately document complaints, appeals, and resolutions in the system.
- Conduct investigations and gather information needed to resolve appeals.
- Communicate with clients, providers, and internal departments to resolve issues.
- Ensure compliance with regulatory standards and organizational policies.
- Collaborate with other departments to address systemic issues and prevent future grievances.
- Provide management with regular updates on grievance and appeal status.
- Analyze trends in claims grievances and appeals to identify areas for improvement.
Benefits
- Paid time off starting at 28 days per year, inclusive of vacation, personal/sick time, and seven holidays.
- 100% paid parental leave for up to six weeks.
- Immediate eligibility for retirement plans with employer contributions up to 9.5%.
- Medical, dental, and vision plans.
- Employer-paid disability and life insurance.
- Well-being programs, including an on-site employee fitness center and the RESTORE Center.
- Free RTD EcoPass for public transportation.
- Childcare discount programs and discounts on brands and travel.
- Tuition reimbursement and assistance.
- Education, coaching, and professional development opportunities through the Workforce Development Center.
- Career advancement pathways and internal career growth opportunities.
- Public Service Loan Forgiveness-eligible employer, with student loan coaching and assistance navigating the program.
- National Health Service Corps and Colorado Health Service Corps eligible employer.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
