Grievance &Appeals Coordinator

Title: Grievance & Appeals Coordinator

Location: Detroit, MI

Type: Remote for candidates located in EST and CST (No Florida applicants at this time)

Role Type: W2 contract with potential for FTE

Pay Rate: $30-32/hour

Job Description

Process grievances and organization determinations, 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.

Qualifications

• Bachelor's Degree in Health Care Administration, English, Communications or related field preferred.
• Two (2) years customer service experience required.
• Two (2) years health insurance experience and familiarity with health insurance state and federal regulations preferred.
• Strong project management skills preferred including management of personal inventory.
• Strong analytical, critical thinking, organizational, time management and problem resolution skills.
• Excellent verbal and written communication skills.
• Strong PC applications (i.e. Microsoft Excel, Word, and Outlook).
• High regard for protecting confidentiality of corporate information.
• Proven ability to foster and maintain open, collaborative and constructive relationships within internal, external and leadership to achieve departmental and corporate results.
• Ability to apply policies and procedures to arrive at accurate conclusions.
• Ability to analyze, interpret, apply reason and logic, conduct research structure a clear and thorough response.
• Ability to quickly learn and navigate diverse products and information systems.
• An understanding of MA servicing structure related to grievance and appeals or experience in claims with the ability to apply EOC research in prepping cases preferred.
• Previous experience with Health Insurance preferred.
• Demonstrates one can handle multiple tasks/projects concurrently with minimal supervision.

Medicare Advantage

• Accountable for CMS Chapter 13, CMS Audit Compliance and Star Quality Measures: a. Member rights, b. Timely decisions about appeals, c. Fairness of the health plan's appeal decisions based on an independent reviewer.
• Data entry accuracy is required.
• Full understanding of Medicare Advantage servicing environment is preferred.

Job ID: JOB-236677
Publish Date: 24 Jul 2024