Grievance and Appeals needs 3+ years' experience
Grievance and Appeals requires :
- Customer Service / escalation experience
- Grievance and Appeals experience
- Experience with Medicaid / Medicare member correspondence
- Experience with managed vision care and / or insurance
Grievance and Appeals duties :
- Responsible for leading the resolution of member or provider complaints and grievances relative to quality of care, access to care, and benefit determination.
- Member and Providers Complaints / Grievances.
- Serves as a liaison between provider and member or member's representative with regard to resolution of Member complaints.
- Conducts research and secures required information, including requesting member records, claims analysis, transaction / event documentation.
- Prioritizes and analyzes member and provider issues
Quality Assurance Specialist - Grievance and Appeals
Meets established quality and productivity standards in all areas of complaints and grievances, including client performance guarantees and any federal and/or state regulations as they relate to complaints and grievances. Maintains all documentation associated with the processing and resolution of c...
Grievance and Appeals
Grievance and Appeals needs 3+ years' experience. Grievance and Appeals requires:. Grievance and Appeals experience. Responsible for leading the resolution of member or provider complaints and grievances relative to quality of care, access to care, and benefit determination. ...
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