Grievance & Appeals Coordinator I

Grievance & Appeals Coordinator I

Requirements

• High school diploma or equivalent
• Associate’s degree preferred
• 2+ years grievance or appeals, claims or related managed care experience
• Strong oral, written, and problem solving skills

Responsibilities

• Analyze and resolve verbal and written claims and authorization appeals from providers
• Gather, analyze and report verbal and written member and provider complaints, grievances and appeals
• Prepare response letters for member and provider complaints, grievances and appeals
• Maintain files on individual appeals and grievances
• May coordinate the Grievance and Appeals Committee
• Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information
• Assist with HEDIS production functions including data entry, calls to provider’s offices, and claims research
• Manage large volumes of documents including copying, faxing and scanning incoming mail

Preferred Qualifications

• Associate’s degree preferred