Appeals And Grievances Coordinator Jobs

• Review and interpret product and benefit designs according to State and Federal regulatory requirements

Education: Associates Degree or equivalent experience in health care, conflict resolution or related field.

• Health care benefit and regulatory knowledge preferred

• 3-5 years health care or insurance experience

• Knowledge of insurance products, policies and procedures preferred.

• Requires excellent interpersonal skills in order to communicate and work with multiple constituents.

5 years of analytical skills and experience (query data, excel, and SharePoint)

Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of NCQA guidelines for appeals and denials.

Guides staff by providing technical knowledge and functions as a subject matter expert to staff.

Experience with process improvement initiatives

Serves as a lead for incoming analysts by providing support.

Trains new employees and provides guidance to others with respect to the more complex appeals and grievances.