Title: Grievance & Appeals Coordinator
Work Location: Detroit MI 48226
Duration: Long Term
Job Type: Contract
Work Type: Remote

Job Description:

• 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 it 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 are 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 with 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
• have previous customer service experience and excel at customer servicing.
• have the ability to use and apply previous experiences and knowledge when encountering new or unfamiliar situations
• professional in conduct
• ability to work independently or with minimal oversight
• ability to work in a fast paced environment with tight deadlines and high quality standards
• ability to work well under stressful circumstances

Job Type: Contract

Salary: $30.00 - $35.00 per hour

Schedule:

• 8 hour shift

People with a criminal record are encouraged to apply

Experience:

• escalation calls from customers regarding their Insurance: 3 years (Required)
• resolve the appeals, dispute, grievances: 3 years (Required)
• Call center environment: 3 years (Required)
• Claims processing & guidelines: 3 years (Required)

Work Location: Remote

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