Intake Specialist Appeal and Grievance - Health Plan

BayCare • Clearwater, FL

401d

About The Position

The Intake Specialist for Appeals and Grievances at BayCare is responsible for managing and processing customer appeals and grievances in compliance with established guidelines and legal regulations. This role serves as the primary point of contact for customers, ensuring their concerns are documented and addressed effectively. The specialist will also prepare reports on the status of appeals and grievances, maintaining knowledge of relevant laws and policies to ensure accurate processing and resolution of cases.

Requirements

• High school diploma or GED required.
• 1 year of experience in Customer Service, Claims, Appeals, or Healthcare Administration.
• Knowledge of healthcare or insurance industry regulations is highly desirable.

Nice To Haves

• Previous experience in handling Appeals and Grievances is a plus.

Responsibilities

• Handle and process customer appeals and grievances according to established guidelines and legal regulations.
• Receive and document customer appeals and grievances via phone, email, and online portals.
• Ensure accurate and timely processing of all intake information according to company and regulatory standards.
• Assign cases to appropriate departments for review and resolution.
• Serve as the first point of contact for customers wishing to appeal decisions or file grievances.
• Prepare reports on the volume and status of appeals and grievances as requested by management.
• Maintain up-to-date knowledge of all relevant laws and policies.
• Adhere to deadlines for case resolution and reporting requirements.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Ambulatory Health Care Services
• Education Level: High school or GED
• Number of Employees: 10,001+ employees