Job Title: Complaints and Issues Specialist III
Location: Location: REMOTE CST OR EST
Duration: 6Months
Pay-Rate: $37.46/Hr. on W2
Position Purpose:
Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.
Education/Experience:
- Education Requirement: Bachelors.
- 2+ years grievance or appeals, claims or related managed care experience.
- Strong oral, written, and problem-solving skills.
Roles and Responsibilities:
- 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 providers offices, and claims research.
- Manage large volumes of documents including copying, faxing, and scanning incoming mail.
Job Types: Full-time, Contract
Pay: $37.46 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
- Day shift
- Monday to Friday
Work setting:
Application Question(s):
- Your email address, contact number and the best time to reach you?
Experience:
- Appeals & Grievances: 4 years (Preferred)
Work Location: In person