Grievance/Appeals Rep Ld-#39904NK - (US-OH-Mason - 45040)

Minimum Education: Tech School
Job Type: Full Time
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Conducts compliance audits on senior Grievance/Appeals Reps and below. As part of the quality improvement process, coaches Grievance/Appeals Reps to achieve quality and timeliness standards and monitors all case handling to ensure consistency and accuracy. Facilitates second level panel meetings. Acts as the liaison with the Legal Department. Performs appeals analysis/trending and pursues recommendations for corrective actions to reduce the number of appeals and/or improve the timeliness of appeal resolution. Assists with the development of training materials and conducts one on one as well as group training. Monitors day to day workflow and provide technical guidance on the most complex of cases.

Skills:
* High School Diploma or GED with experience working in grievances and appeals, understanding of the application of benefits contracts, pricing, policies and legislative regulations, verbal and written communication skills, organizational skills, interpersonal skills, PC proficiency, or any combination of education and/or experience that would provide an equivalent background.* Excellent communnication/organizational skills required* Ability to work overtime/weekends.

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