Grievance and Appeals Specialist

  • location: Cerritos, CA
  • type: Temporary
  • salary: $21 - $22 per hour
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job description

Our client, located in Cerritos, CA currently has an opening for a Grievance and Appeals Specialist

Responsibilities:
Under minimal supervision, provides and is responsible for, in accordance with established policies and procedures, the research and documentation of written and verbal complaints and appeals filed by members, providers and external agencies.
Investigates member claims or billing discrepancies and coordinates with Claims Department in order to successfully achieve corrective actions and resolution.
Maintains confidentiality of patient information, meets productivity and quality of work standards on an ongoing basis.
Demonstrates an understanding of the functions of other departments and affiliates while communicating appropriately to maintain positive working relationships
The Coordinator is responsible for identifying issues, grievances, and appeals to categorize and enter information into the database, creating an individual file folder.
The supporting documents and data are entered for resolving the issue and corresponding with the party according to regulatory requirements

Working hours: 8 AM - 5 PM

Skills:
Research and respond to participants appeals
Contact participants and providers regarding outcomes
Excellent written and verbal communication skills

Qualifications:
Please apply at www.randstadusa.com for consideration!

Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad. EEO Employer: Race, Religion, Color, National Origin, Citizenship, Sex, Sexual Orientation, Gender Identity, Age, Disability, Ancestry, Veteran Status, Genetic Information, Service in the Uniformed Services or any other classification protected by law. San Francisco Fair Chance Ordinance: Qualified applicants in San Francisco with criminal histories will be considered for employment in accordance with the San Francisco Fair Chance Ordinance.

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