Grievance and Appeals Coordinator

Job Summary

A company is looking for a Coordinator, Grievance and Appeals.

Key Responsibilities

• Administer standard and expedited appeals processes in compliance with regulatory standards
• Act as the primary investigator for member grievances and appeals, ensuring proper documentation and resolution
• Gather documentation and research outcomes for Clients/Plan Sponsors within required timeframes

Required Qualifications

• High School Diploma or equivalent required; 2 years post high school education or bachelor's degree preferred
• 2-3 years of managed care and/or insurance background preferred
• Experience with CMS and/or NCQA audits strongly desired
• Proven success in documenting case files and managing multiple cases within required timeframes
• Ability to interact cooperatively and respectfully with other employees