Grievance and Appeals Coordinator

Job Summary

A company is looking for a Grievance & Appeals Coordinator I to analyze and resolve claims and authorization appeals.

Key Responsibilities

• Gather, analyze, and report member and provider complaints, grievances, and appeals
• Prepare response letters for complaints, grievances, and appeals
• Manage large volumes of documents including copying, faxing, and scanning incoming mail

Required Qualifications

• High school diploma or equivalent; associate's degree preferred
• 2+ years of experience in grievance or appeals, claims, or related managed care
• Experience with HEDIS production functions
• Ability to maintain files on individual appeals and grievances
• Experience in supporting pay-for-performance programs