Grievance & Appeals Coordinator

• Remote Positions for Candidates in Michigan
• Analyze, investigate, and resolve appeals, complaints, and grievances.
• Provide comprehensive and thorough responses in compliance with Client guidelines, state and federal regulations, and accreditations standards.
• Interact with internal and external customers and subject matter experts to gather information, build a case, and make decision to maintain or reverse appeal or grievance.
• Analyze and interpret systems data, contract language, regulatory provisions, and apply to casework.
• Adhere to policies, procedures, and audit standards to remain compliant and audit ready.

• Critical thinking, problem solving, analytical skills
• Letter writing and proofreading
• 2 years Customer service/concierge services
• PC Applications
• Excellent verbal and written communication skills
• Organizational/Time Management
• 2 years health insurance experience and familiarity with health insurance state and federal regulations

• Bachelors Degree in English, Communications, or related field

Last updated on Nov 22, 2022