Grievance & Appeals Coordinator I

Grievance & Appeals Coordinator I

Requirements

• Grievance experience is required.
• Applicants must be residents of Indiana to be considered.
• High school diploma or equivalent.
• 2+ years grievance or appeals, claims or related managed care experience. Strong oral, written, and problem solving skills.

Responsibilities

• Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.
• 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.

Preferred Qualifications

• Associate’s degree preferred.