Grievance and Appeals Specialist
Our client, located in Cerritos, CA currently has an opening for a Grievance and Appeals Specialist
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: 8:00 AM - 5:00 PM
Research and respond to participants appeals
Contact participants and providers regarding outcomes
Excellent written and verbal communication skills
Please apply at www.randstadusa.com for consideration!
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