Intake Coordinator – Integrated Grievances and Appeals

This is a fully remote position, open to applicants in Alabama, +43 more states.

📋 Description

• Assess, investigate, and record grievance and appeal cases within one business day of receipt.

• Oversee call tracking, fax, email, and mail intake channels while prioritizing incoming requests.

• Process member appeals, member grievances, provider grievances, and provider/claim appeals.

• Identify the appropriate case types and processing requirements from incoming data.

• Handle cases with varying turnaround times according to state regulations, plan guidelines, and case type.

• Ensure that urgent and expedited requests are addressed promptly.

• Collaborate with Quality Assurance to guarantee accurate case entry and completion of necessary information.

• Address QA inquiries and feedback, seeking clarification when necessary.

• Engage in weekly meetings with Intake Coordinators, analysts, Quality team members, managers, and project managers.

• Adjust to evolving procedures, requirements, priorities, and workflows while maintaining accuracy and productivity.

⛳️ Requirements

• Minimum of 2 years of relevant experience.

• Proficient in problem-solving and decision-making skills.

• Strong critical thinking abilities.

• Experience in data entry.

• Knowledge of grievance and appeals processes.

• High School Diploma or equivalent qualification.

• At least 1 year of experience in grievance and appeals is preferred.

• Background in Medicare and Medicaid is advantageous.

• Experience in intake processes is preferred.

• Familiarity with health insurance is a plus.

• Capability to work 40 hours per week.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being, contingent on eligibility.