Sep 28, 2018
Full time
GENERAL DESCRIPTION OF POSITION The Grievance and Appeals Coordinator is responsible for the beginning-to-end process of receiving, researching and resolving of new and existing member and provider grievance and appeals cases for all lines-of-business including any escalated step of the grievance and appeals process in accordance with state and federal regulatory requirements and policies and procedures as set forth for each line of business.
Act as a back-up to the Grievance and Appeals Intake Specialist during times of high volume work and/or staffing shortages to ensure appropriate intake of new and existing grievance and appeal cases, assessing the priority of each case and routing to the appropriate staff.
Ensure grievance and appeals cases are accurate and include the necessary elements for processing and resolving, giving special attention to those identified as “Expedite”. Create clear and concise documentation in applicable system(s).
Use good judgment and department resources to identify all issues and required actions within a case, appropriately categorize cases and identify required actions in accordance with state and federal regulations.
Required:
• High School diploma or GED. (R)
•Minimum two years of experience in customer service, provider service, health service, or pharmacy in a managed care or health care environment handling escalated or complex issues. (R)
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