|
Search Jobvertise Jobs
| |
Jobvertise
|
Grievance and Appeal Coordinator
Location: US-MI-Detroit
Email this job to a friend
Report this Job
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 and Appeal Coordinator Work Location: Detroit, MI 48243 Work Type: Remote (In person interview Mandatory) -
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. -
We are looking for individuals who have superior customer service/concierge skills and experience, and capable of making decisions based on gathered evidence and facts, working in a high stress, high volume, and heavily audited area. -
Currently, our team works remotely. Those selected for the position will be provided a laptop. To work from home successfully, candidates must have a minimum internet speed of 24mbps. -
While working from home, most individuals benefit greatly by having a dedicated work area/office in their respective homes and an additional monitor. The monitor is not provided by Client. Candidates should have the following skills and attributes: -
excellent verbal and written communication skills. -
have strong letter writing and proofreading skills. -
strong PC application and system skills- having the ability to navigate multiple computer systems and databases. -
be analytical, having the ability to examine a matter, the facts, contextual information and make an informed decision or implement and execute a reasonable, rational resolution. -
have the ability to work with a sense of urgency -
have high attention to detail and remain organized -
have high regard for quality work, accuracy, and confidentiality - TekWissen Group
|
