Arizona Licensed Grievance Coordinator

Job Summary

A company is looking for a Grievance & Appeals Coordinator II.

Key Responsibilities

• Review and process member and provider grievances and appeals in accordance with regulations and policies
• Prepare cases for medical review and collaborate with subject matter experts on complex cases
• Serve as a liaison between members, providers, regulatory agencies, and internal staff regarding grievance and appeal decisions

Required Qualifications

• Bachelor's degree in a related field or equivalent experience
• 2+ years of experience in claims, contracting, or a related managed care environment
• Knowledge of federal, state, and organizational regulations regarding grievances and appeals
• Experience leading committees or teams related to appeals and grievances
• Ability to analyze and resolve complex claims and authorization issues