Grievance and Appeals Coordinator

Job Summary

A company is looking for a Coordinator, Grievance and Appeals.

Key Responsibilities

• Administrate Standard and Expedited Appeals Processes in compliance with regulatory requirements
• Act as the primary investigator for grievances and appeals, ensuring proper documentation and resolution
• Gather documentation and provide research outcomes to Clients/Plan Sponsors within required timeframes

Required Qualifications

• High School Diploma or equivalent required; 2 years post high school education or bachelor's degree preferred
• 2-3 years of managed care and/or insurance background preferred
• Experience with CMS and/or NCQA audits strongly desired
• Proven success in documenting case files and managing multiple cases within required timeframes
• CPhT certification or ability to obtain is desired and preferred