Grievance and Appeals Coordinator

Job Summary

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

Key Responsibilities

• Gather, analyze, and report on member and provider complaints, grievances, and appeals
• Prepare response letters for complaints, grievances, and appeals from members and providers
• Maintain files on individual appeals and grievances and support pay-for-performance programs

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 in managing large volumes of documents
• Ability to work a Monday through Friday schedule from 8:00 AM to 5:00 PM Eastern Time
• Participation in a holiday rotation, requiring work on up to two holidays per year