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Grievance Appeals Coordinator
Location: US-MI-Detroit
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TekWissen Group is a workforce management provider throughout the USA and many other countries in the world. Our client is a health insurance company. It offers different types of health care coverage plans that include individual and family, dental and vision, plans for employers, etc. Title: Grievance & Appeals Coordinator Work Location: Detroit MI 48226 Dept: Grievance & Appeals Coordinator -
Analyze, investigate, and resolve appeals, complaints, and grievances. Provide comprehensive and thorough responses in compliance with CMS guidelines, state and federal regulations, and accreditations standards. -
Interact with internal and external customers and subject matter experts to gather information, build a case, and make decision to maintain or reverse appeal or grievance. -
Analyze and interpret systems data, contract language, regulatory provisions, and apply to casework. Adhere to policies, procedures, and audit standards to remain compliant and audit ready. Top 3 Required Skills/Experience -
Critical thinking, problem solving, analytical skills -
Letter writing and proofreading -
2 years Customer service/concierge services Required Skills/Experience The rest of the required skills/experience. Include: -
PC Applications -
Excellent verbal and written communication skills -
Organizational/Time Management -
2 years health insurance experience and familiarity with health insurance state and federal regulations Preferred Skills/Experience Optional but preferred skills/experience. Include: Education/Certifications Include: |
