Grievance and Appeals Coordinator

Job Summary

Analyzing and resolving verbal and written claims, the full-time Grievance and Appeals Coordinator will handle provider appeals and member grievances while working remotely.

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 assist with HEDIS production functions

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 data entry and managing large volumes of documents