Grievance and Appeals Specialist (Hybrid)

Grievance and Appeals Specialist

VillageCareMAX

112 Charles Street, New York, NY 10014

VillageCare is looking for a self-motivated individual for a Full Time role as the Grievance & Appeals Specialist. This position ensures that grievances and appeals are resolved accurately and appropriately while advocating for members. The specialist will act independently and communicate with providers, physicians, and Plan's departments to investigate and resolve grievances and appeals. Some daily activities will include:

• Receive, process, categorize and perform initial research on Grievance & Appeals.
• Correspond with members and document as required by regulations.
• Accurately complete data entry and system documentation.
• Compliance with all regulatory and departmental timelines.
• Participate on projects and individual special assignments as needed.

We would like to speak to those who have an Associate's Degree in a related field along with 2-3 years of work experience in an
Insurance Company, Workers Compensation, Disability, HMO or MLTC. Knowledge of appeals and grievances, claims processing or utilization management/case management in a managed care organization required. Proficient with general computer software including Microsoft Excel, Word and Outlook .

Must reside within the New York Tri-State Area - NY, NJ, or CT.

There are many benefits to working for VillageCare. If you are someone who likes being part of a team, enjoys a highly competitive benefits package from world leading carriers and competitive compensation, than we would love to speak with you!

• PTO package
• 10 Paid Holidays
• Personal and Sick time
• Medical/Dental/Vision
• HRA/FSA
• Education Reimbursement
• Retirement Savings 403(b)
• Life & Disability
• Commuter Benefits
• Paid Family Leave
• Additional Employee Discounts

VillageCare offers a wide range of at-home and community-based services, as well as managed long-term care options that seek to match each individual's needs to help them attain and maintain the greatest level of independent living possible. We are committed to superior outcomes in quality health care.