Grievance & Appeals Coordinator:

Engagement Description

The Grievance and Appeals (G&A) Coordinator is responsible for processing appeals, grievances, complaints, and inquiries received from members, providers, authorized representatives, and regulatory agencies. The Coordinator is expected to analyze the customers concerns, conduct necessary research by leveraging various internal and external resources and contacts in order to make appropriate and accurate case decisions. Appeal Coordinators are expected to coordinate, facilitate, and conduct managerial level conferences with customers and their authorized representatives to gather and relay information. The Coordinator is expected to keep an accurate documentation record that details steps and action taken to resolve the customers concerns. The outcome and resolution of all appeals, grievances, complaints, and inquiries is communicated via written correspondence to the customer using clear and simple language and include elements that satisfy corporate, regulatory, and accreditation timeframes, accuracy and response guidelines. The Coordinator is responsible for staying abreast of products, networks, internal policies, procedures and regulations for the accurate resolution of appeals, complaints, grievances, and inquiries.

Top 3 Required Skills/Experience

• Excellent written and verbal communication skills. Must be proficient in proofreading, spelling, grammar, punctuation, and math


• Previous customer service or concierge experience


• Strong PC application and system skills- having the ability to navigate multiple computer systems and databases

Required Skills/Experience

• Excellent written and verbal communication skills. Must be proficient in proofreading, spelling, grammar, punctuation, and math


• Previous customer service or concierge experience


• Strong PC application and system skills- having the ability to navigate multiple computer systems and databases


• Analytical mindset- having the ability to examine a matter, the facts, contextual information and make an informed decision or implement a reasonable, rationale solution.


• Ability to apply policies and procedures to arrive at accurate conclusions


• Ability to analyze, interpret, apply reason and logic, conduct research; structure a clear and thorough response


• Ability to work in a fast-paced environment with tight deadlines and high quality standards


• Problem solving aptitude


• Accuracy and strong attention to detail


• Ability to prioritize responsibilities and effectively manage time


• Ability to work effectively with management and part of a team to meet targets


• High regard for protecting confidentiality of member, employee, corporate and performance information.

Preferred Skills/Experience Previous health care or health insurance industry experience

Education/Certifications Bachelors Degree in English, Communication, Health Care Administration, or related field