Grievance & Appeals Claims Specialist - Denver Health Medical Plan (Must Live in Colorado. Weekly On Site Requirement.)

Denver Health•Denver, CO

5d•$24 - $34•Hybrid

About The Position

The Grievance & Appeals Claims Specialist is a key position responsible for handling and resolving client grievances and appeals regarding services and claims. This role ensures that all complaints are addressed promptly and accurately, maintaining compliance with regulatory standards and company policies. The specialist is an advocate for clients, working to resolve issues and improve overall satisfaction while safeguarding the integrity and efficiency of the organization.

Requirements

High School Diploma or GED required
Associate's Degree preferred
Associates degree and 1 year of claims, customer service, or grievance and appeals experience required
3 years of experience in the insurance industry required. Claims preferred
1 year of QNXT experience required
Strong knowledge of regulatory requirements and insurance products.
Excellent communication and interpersonal skills.
Proven analytical and problem-solving abilities.
Ability to handle sensitive and confidential information appropriately.
Proficiency in using relevant software and database systems.
Strong organizational and time-management skills.
Understanding of grievance and appeals processes.
Strong written and verbal communication skills.
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

Responsibilities

Handle and resolve incoming grievances and appeals in a timely and efficient manner (20%)
Document all complaints, appeals, and resolutions accurately in the system. (20%)
Conduct thorough investigations to gather necessary information for resolving appeals. (10%)
Communicate effectively with clients, providers, and internal departments to resolve issues. (10%)
Ensure compliance with regulatory standards and organizational policies. (10%)
Collaborate with other departments to address systemic issues and prevent future grievances. (10%)
Provide regular updates to management on the status of grievances and appeals. (10%)
Analyze trends in claims grievances and appeals to identify areas for improvement. (10%)

Benefits

Generous paid time off
Fully paid parental leave
Exceptional retirement contributions
Comprehensive health coverage
Nationally recognized well-being programs
Tuition assistance
Career advancement pathways
Professional development
Loan forgiveness eligibility
Employer contributions
Paid time off starting at 28 days per year, inclusive of vacation, personal/sick, and 7 Holidays
100% paid parental leave up to 6 weeks
Immediate eligibility for retirement plans with employer contribution up to 9.5%
Generous medical, dental, vision plans in addition to employer paid disability and life insurance.
Comprehensive well-being programs including on-site employee fitness center located on Denver Health main campus and nationally recognized RESTORE Center
Free RTD EcoPass (public transportation)
Childcare discount programs & exclusive perks on large brands, travel, and more
Tuition reimbursement & assistance
Education, coaching, and professional development opportunities through the Workforce Development Center (WFDC) that support internal career growth and advancement pathways
Professional clinical advancement program & shared governance
Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program
National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer