Grievance and Appeals Coordinator

Job Summary

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

Key Responsibilities

• Analyze and resolve grievances and appeals from providers and members
• Review and process grievances for reconsideration and prepare cases for medical review
• Act as a liaison between members, providers, and regulatory agencies while leading the Appeals and Grievance Committee

Required Qualifications

• Bachelor's degree in a related field or equivalent experience
• 2+ years of claims, contracting, or related experience in a managed care environment
• Experience with federal, state, and organizational regulations and policies
• Ability to collaborate with subject matter experts on complex cases
• Experience in customer service or call center environments is a bonus