Job Summary

A health insurance provider needs applicants for an opening for a Remote Appeals and Grievances Quality Assurance Auditor.

Core Responsibilities of this position include:

• Completing random case audits for all IFP/Commercial A&G Team members
• Providing coaching, and training, to all new hires and to A&G staff when errors are received
• Ensuring TAT, quality scores and other A&G goals are met

Qualifications Include:

• High School Diploma or equivalent
• Two (2) years of experience working in Appeals and Grievances experience
• Three or (3) or more years of experience in health plan operations setting
• Able to understand regulatory and compliance rules surrounding appeals & grievances
• Ability to participate in the discovery and resolution of root cause for recurring issues