Grievance & Appeals Coordinator I
Professional Management Enterprises
Job Title:
Grievance & Appeals Coordinator I
Location: Remote in Indiana (**MUST be a resident of Indiana)
Pay: $22 hourly - *weekly pay
Position Purpose:
Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.
Education/Experience:
High school diploma or equivalent. Associate’s degree preferred. 2+ years grievance or appeals, claims or related managed care experience. Strong oral, written, and problem solving skills.
- Gather, analyze and report verbal and written member and provider complaints, grievances and appeals
- Prepare response letters for member and provider complaints, grievances and appeals
- Maintain files on individual appeals and grievances
- May coordinate the Grievance and Appeals Committee
- Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information
- Assist with HEDIS production functions including data entry, calls to provider’s offices, and claims research.
- Manage large volumes of documents including copying, faxing and scanning incoming mail
Vacancy posted 1 day ago
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