Grievance and Appeals

Immediate need for a talented Grievance and Appeals. This is a 06+months contract to Hire opportunity with long-term potential and is located in CA(Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID: 25-72281

Pay Range: $21 - $22/hour.  Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Shift Time: Monday through Friday 8am to 5pm with overtime as need (mandatory)  and occasional Saturdays/holidays if work is at risk.  
• 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.

Key Requirements and Technology Experience: 

• Key Skills; G&A Exp
  Knowledge of healthcare/terminology
• Knowledge of healthcare/terminology
• Nice to haves: Member Appeals & Grievances, healthcare call center, customer service
• Education HS

Our client is a leading Healthcare Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

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