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Grievance and Appeals Coordinator
A company is looking for a Grievance & Appeals Coordinator II to analyze and resolve claims and authorization grievances and appeals from providers and members. Key Responsibilities Review and process member and provider grievances and appeals in compliance with regulations and policies Collaborate with subject matter experts to obtain clinical opinions on complex cases Lead the Appeals and Grievance Committee while serving as a subject matter expert in grievances and appeals Required Qualifications Bachelor's degree in a related field or equivalent experience 2+ years of experience in claims, contracting, or a related field within a managed care environment
A company is looking for a Grievance & Appeals Coordinator II to analyze and resolve claims and authorization grievances and appeals from providers and members.
Key Responsibilities
Review and process member and provider grievances and appeals in compliance with regulations and policies
Collaborate with subject matter experts to obtain clinical opinions on complex cases
Lead the Appeals and Grievance Committee while serving as a subject matter expert in grievances and appeals
Required Qualifications
Bachelor's degree in a related field or equivalent experience
2+ years of experience in claims, contracting, or a related field within a managed care environment