Appeal and Grievance Coordinator - MUST live in KY, OK, and OH
Core
Intake, investigation, and resolution of appeals, complaints, and grievances for health products, ensuring timely responses and identifying trends.
Role type
Appeals and Grievance Coordinator
Builds
Final resolution responses and closure communications for members and providers
Domain
Health insurance / Claims administration
Deliverable
client delivery
Required skills
Benefit language research, claim processing logic verification, regulatory compliance knowledge, clinical terminology, data analysis, policy interpretation
Preferred skills
Claim processing research and analysis
Technologies
Excel, Microsoft Word
Responsibilities
Research incoming appeals to determine unit appropriateness, verify claim payment accuracy and member eligibility, coordinate components across business units, communicate final resolutions to members/providers, identify trends and recommend solutions
Seniority
Entry-level to Mid-level, hands-on IC