Grievance & Appeals Coordinator

$19 - $34/Yr

Elevance Health - Houston, TX

Part-time - Entry Level

Houston, TX

Insurance Carriers and Related Activities

About the position

The Grievance & Appeals Coordinator is responsible for investigating and reviewing customer grievances and appeals regarding provision of service and benefit coverage issues. This position will work remotely, and the ideal candidate will live within 50 miles of an Elevance pulse point in specific states. The role involves triaging clinical and non-clinical inquiries, grievances, and appeals, and preparing case files for member grievance committees/hearings. The working hours are Friday to Monday from 8:30 am until 7:00 pm CST.

Responsibilities

• Summarizes and presents essential information for the clinical specialist or medical/dental director and legal counsel.
• Responds to oral and written complaints sent to the Office of the Chairman, President or Vice President complaints.
• Ensures appropriate resolution to inquiries, grievances and appeals within specified timeframes established by either regulatory/accreditation agencies or customer needs.
• Contacts members to gather information and communicate disposition of case; documents interactions.
• Generates written correspondence to members, providers and regulatory agencies.
• Identifies barriers to customer satisfaction and recommends actions to address operational challenges.
• Pursues ongoing education/training on benefits/services to ensure accurate resolution of grievances and appeals, and overall industry knowledge and development.
• Operates a PC/image station to obtain and extract information; documents information, activities and changes in the database.

Requirements

• Requires a HS Diploma or equivalent and 4 years progressively complex experience working in grievances and appeals; or any combination of education and experience which would provide an equivalent background.

Nice-to-haves

• Proficient utilizing Microsoft Office, specifically Excel.

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution