Grievance and Appeals Coordinator

A company is looking for a Grievance & Appeals Coordinator II.

Key Responsibilities

Analyze and resolve claims and authorization grievances / appeals from providers and members

Review and process grievances and appeals in compliance with regulations and policies

Serve as a liaison between members, providers, and regulatory agencies

Required Qualifications

Bachelor's degree in a related field or equivalent experience

2+ years of experience in claims, contracting, or managed care

Experience with grievance and appeals processes

Familiarity with relevant software such as Omni, Prime, TruCare, and Amysis is preferred

Ability to lead and collaborate with internal subject matter experts