California Licensed Grievance Specialist

Job Summary

A company is looking for a Grievance & Appeals Resolutions Specialist.

Key Responsibilities

• Responds to incoming calls from providers regarding Provider Dispute Resolution (PDR)
• Performs research, investigation, and resolution of Provider Disputes
• Reports and tracks all Provider disputes inventory received, assigned, and completed

Required Qualifications

• High School Graduate or General Education Degree (GED) required
• 3+ years of experience in claim processing or provider disputes review
• Experience in a managed care environment is a plus
• Advanced computer skills, including MS Office products
• Ability to maintain confidentiality regarding sensitive information