Grievance & Appeals Coordinator

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

Key Responsibilities

Analyze and resolve claims and authorization appeals from providers and formal grievances from members

Prepare response letters for complaints, grievances, and appeals

Maintain files on individual appeals and grievances and support pay-for-performance programs

Required Qualifications

High school diploma or equivalent; associate's degree preferred

2+ years of experience in grievance or appeals, claims, or managed care

Experience with data entry and document management

Familiarity with HEDIS production functions

Ability to work remotely and manage large volumes of documents