Grievance & Appeals Coordinator (12 of 13)

OpTech•Detroit, MI

53d

About The Position

Engagement Description: Process appeals and grievances, analyze, research, and provide comprehensive responses in accordance with established regulatory and accreditation guidelines Contact customers to gather information and communicate disposition of case Conduct pertinent research in order to evaluate, respond to, and finalize case Familiar with standard concepts, practices, and procedures for analyzing, interpreting data and applying contract and regulatory provisions

Requirements

Experience handling a large load of work in a fast-paced environment and have computer skills!
Insurance, Medicare/CMS knowledge
Customer Service Experience
Writing Letters
Analytical thinker
Research Skills
Multi-task
Two (2) years customer service experience required

Nice To Haves

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
Two (2) years health insurance experience and familiarity with health insurance state and federal regulations preferred
Strong project management skills preferred

Responsibilities

Process appeals and grievances, analyze, research, and provide comprehensive responses in accordance with established regulatory and accreditation guidelines
Contact customers to gather information and communicate disposition of case
Conduct pertinent research in order to evaluate, respond to, and finalize case
Familiar with standard concepts, practices, and procedures for analyzing, interpreting data and applying contract and regulatory provisions