Specialist - Grievance and Appeals

Job Description

Job Description

Job Title : Specialist (Grievance and Appeals)

Location : Detroit, MI (HYBRID)

Duration : 10+ months

Engagement Description

Under general supervision is responsible for assisting and supporting management in the execution, evaluation, recommendation, establishment, implementation and of production workflows, work processes for systems, reporting and new products / programs to improve customer service levels and overall quality.

Top 3 Required Skills / Experience

• Handle escalated servicing issues by way of CMS' Complaints Tracking Module.
• Ability to work with external parties directly, such as providers and members, to resolve issues / problems and effectively communicate findings.
• Work cross departmentally to address enrollment, claims, benefit, eligibility, and billing matters.

Required Skills / Experience The rest of the required skills / experience. Include :

• Maintain confidentiality of all information processed.
• Assist and support in the planning, coordinating, developing, and implementing of approved projects which are Divisional and / or Corporate in scope to enhance the overall efficiency of operational procedures, methods, controls, and performance.
• Analyze, process and / or expedite operational transactions; this may include timely resolution of problems.
• Participate in systems testing, develop procedures / controls and provide recommendations for the ongoing improvement of the updated process.
• Provide leadership team with status of projects; issue, communicate and recommend policy decisions to achieve project objectives.
• Utilize and maintain available corporate production and reporting systems; produce routine and non-routine reports, presentations, letters communications and graphics.
• Assist personnel (both internal and external) by answering questions, supplying information and training.
• Develop and maintain an effective working relationship with customers or partners

Preferred Skills / Experience Optional but preferred skills / experience. Include :

• Excellent analytical, organizational, planning, and follow-up skills.
• Ability to work collaboratively in a team environment, including remotely,
• Excellent verbal and written skills, including expertise in writing for digital and social media and video,
• Ability to exercise independent judgment, meet deadlines and deliver on projects while working under limited supervision.
• Ability to comprehend complex company documents, procedures, and policies, and distill these into easy-to-understand language that supports corporate strategy.

Education / Certifications Include :

High School Graduate or GED equivalent required.

Three (3) to five (5) years of experience with benefits and procedures as related to assigned department.

Company Description

About Kyyba :

Founded in 1998 and headquartered in Farmington Hills, MI, Kyyba has a global presence delivering high-quality resources and top-notch recruiting services, enabling businesses to effectively respond to organizational changes and technological advances.

At Kyyba, the overall well-being of our employees and their families is important to us. We are proud of our work culture which embodies our core values;

incorporating value, passion, excellence, empowerment, and happiness, creates a vibrant and productive atmosphere. We empower our employees with the resources, incentives, and flexibility that they need to support a healthy, balanced, and fulfilling career by providing many valuable benefits and a balanced compensation structure combined with career development.

Company Description

About Kyyba : r nFounded in 1998 and headquartered in Farmington Hills, MI, Kyyba has a global presence delivering high-quality resources and top-notch recruiting services, enabling businesses to effectively respond to organizational changes and technological advances.

r nAt Kyyba, the overall well-being of our employees and their families is important to us. We are proud of our work culture which embodies our core values;

incorporating value, passion, excellence, empowerment, and happiness, creates a vibrant and productive atmosphere. We empower our employees with the resources, incentives, and flexibility that they need to support a healthy, balanced, and fulfilling career by providing many valuable benefits and a balanced compensation structure combined with career development.