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Grievance & Appeals Coordinator
Elevance Health - Waukesha, WI
posted 8 days ago
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. Triages clinical and non-clinical inquiries, grievances and appeals, prepares case files for member grievance committees/hearings. This position will work remotely, and the ideal candidate will live within 50 miles of an Elevance pulse point, in one of the following states: Florida, Illinois, Minnesota, Iowa, Kansas, Colorado, Texas, or Tennessee. The working hours are Friday - 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
