Grievance and Appeals Coordinator

Job Summary

A company is looking for a Grievance & Appeals Coordinator II.

Key Responsibilities

• Analyze and resolve claims and authorization grievances/appeals from providers and members
• Review and process grievances and appeals in compliance with regulations and policies
• Serve as a liaison between members, providers, and regulatory agencies

Required Qualifications

• Bachelor's degree in a related field or equivalent experience
• 2+ years of experience in claims, contracting, or managed care
• Experience with grievance and appeals processes
• Familiarity with relevant software such as Omni, Prime, TruCare, and Amysis is preferred
• Ability to lead and collaborate with internal subject matter experts