Job Description
Grievance and Appeals Coordinator
W2 Contract
Salary Range: $52,000 - $62,400 per year
Location: South San Francisco, CA - Hybrid Role
Job Summary:
As a Grievance and Appeals Coordinator, you will implement Grievance and Appeals processes by resolving complaints filed by members and their representatives, and provide back-up support to member services.
Duties and Responsibilities:
- Research and resolve member complaints for all lines of business, ensuring compliance with Grievance and Appeals policies and procedures.
- Maintain grievance and appeals case files in our database.
- Effectively communicate with members and providers verbally and in writing.
- Prepare summaries and write resolution letters for members, which include summarizing member complaints and steps taken to resolve complaints in clear and grammatically correct language.
- Attend and present cases at the bi-weekly Staff Grievance and Appeals Committee.
- Prepare files for appeals to regulatory agencies.
- Maintain current knowledge of all regulatory requirements for grievance and appeal processes.
- Provide necessary coverage in the call centers for member services as needed.
Requirements and Qualifications:
- Associate's degree in health, business, social sciences, or humanities is preferred.
- 2 years of experience working with Medi-Cal or Medicare in a managed care environment preferred. Work performing grievance and appeals processing preferred.
- Work experience in a call center, claims department, and/or other customer service position required.
- Proficient in Microsoft Office Suite applications, including Outlook, Word, Excel, Access, and PowerPoint.
- Knowledge of Medicare, Medi-Cal, Managed Care, and medical terminology is preferred.
- Able to work as part of a team and support team decisions.
- Effective verbal and written communication skills
- Adaptable to changes in requirements/priorities for daily and specialized tasks.
- Good at summarizing information clearly, thoroughly, and quickly in writing.
- Able to deal with difficult people and situations while providing quality customer service.
- Uses sound judgment, identifies next steps, and develops appropriate solutions.
- Can collaborate with multiple parties to solve problems and can solve problems independently.
Desired Skills and Experience
Health Insurance, Grievance and Appeals, customer service, Medicare, Medi-Cal, Microsoft Office
Bayside Solutions, Inc. is not able to sponsor any candidates at this time. Additionally, candidates for this position must qualify as a W2 candidate.
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Job Tags
Contract work, Work experience placement,