Grievance and Appeals

Grievance and Appeals needs 3+ years’ experience

Grievance and Appeals requires:

• Customer Service/escalation experience

• Grievance and Appeals experience

• Experience with Medicaid/Medicare member correspondence

• Experience with managed vision care and/or insurance

Grievance and Appeals duties:

• Responsible for leading the resolution of member or provider complaints and grievances relative to quality of care, access to care, and benefit determination.

• Member and Providers Complaints/Grievances.

• Serves as a liaison between provider and member or member’s representative with regard to resolution of Member complaints.

• Conducts research and secures required information, including requesting member records, claims analysis, transaction/event documentation.

• Prioritizes and analyzes member and provider issues