Grievance and Appeals Coordinator I

This is a fully remote position, open to applicants in Arizona.

📋 Description

• Evaluate and address both verbal and written claims as well as authorization appeals from providers.

• Seek resolution for formal grievances raised by members.

• Collect, assess, and document verbal and written complaints, grievances, and appeals from members and providers.

• Draft response letters for complaints, grievances, and appeals from members and providers.

• Keep organized records of individual appeals and grievances.

• May oversee the Grievance and Appeals Committee.

• Assist pay-for-performance initiatives through data entry, organization, tracking, and research.

• Support HEDIS production tasks, which include data entry, communication with provider offices, and claims investigations.

• Handle substantial volumes of documentation, encompassing copying, faxing, and scanning of incoming correspondence.

• Execute additional responsibilities as assigned.

• Adhere to all policies and standards.

⛳️ Requirements

• High school diploma or equivalent is required.

• A minimum of 2 years of experience in grievances or appeals, claims, managed care, or relevant fields is necessary.

• An Associate’s degree is preferred.

🏝️ Benefits

• Competitive compensation.

• Health insurance coverage.

• 401K plan.

• Stock purchase options.

• Tuition reimbursement assistance.

• Paid time off along with holidays.

• Flexible work arrangements including remote, hybrid, field, or office schedules.

• Additional incentives may be part of the total compensation package.

• Support for accommodations available for candidates in need.