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Appeals and Grievances Representative, Advanced

Salary undisclosed

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Dice
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JOB DESCRIPTION

Your Role

The Appeals and Grievances Intake team receives, documents, investigates, refers, and coordinates grievances, appeals and complaints. The Appeals and Grievances Coordinator, Advanced will report to the Appeals and Grievances Supervisor. In this role you will be responsible for reviewing, researching and responding to incoming appeals and grievances within established compliance timeframes.

Your Work

In this role, you will:

  • Assist with telephone inquiries regarding member appeals
  • Provide guidance to and act as authoritative source for others within same skill set
  • Research, review and resolve high level/high priority member grievances, appeals and complaints, while clarifying issues and educating customers in the process
  • Provide feedback and training to peers and cross functional teams
  • Identify process improvement opportunities
  • Administer ongoing grievance tracking, trending, and reporting for assigned grievances.
  • Work special projects to enhance best practices


QUALIFICATIONS

Your Knowledge and Experience

  • Requires a high school diploma or GED
  • Requires at least 4 years combined healthcare operations experience such as I&M, Claims, Customer Services, Regulatory Affairs; of which at least 1-year direct experience is in Appeals/Grievances, or similar combination
  • Experience with Appeals and Grievances Intake process preferred
  • General knowledge of applicable legislation/regulations and compliance
  • Basic knowledge of navigating Facets and Microsoft Office applications

Pay Range:

The pay range for this role is: $ 22.70 to $ 31.77 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

#LI-CP3
Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.
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