Grievance Coordinator

Job Summary

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

Key Responsibilities:

• Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members
• Gather, analyze, and report member and provider complaints, grievances, and appeals
• Prepare response letters for member and provider complaints, grievances, and appeals and maintain files on individual appeals and grievances

Required Qualifications:

• High school diploma or equivalent, Associate's degree preferred
• 2+ years of grievance or appeals, claims, or related managed care experience
• Experience in managing large volumes of documents including copying, faxing, and scanning incoming mail
• Residency within the state of California
• Ability to assist with HEDIS production functions including data entry, calls to provider's offices, and claims research