Grievance Coordinator

Job Summary

Analyzing and resolving claims and authorization appeals, the full-time Grievance Coordinator will work remotely to handle verbal and written complaints from providers and pursue resolutions for member grievances.

Key responsibilities:

• Gather, analyze, and report on member and provider complaints, grievances, and appeals
• Prepare response letters for complaints and maintain files on individual appeals and grievances
• Support pay-for-performance programs through data entry, tracking, and researching information

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 HEDIS production functions and claims research is a plus