Grievance & Appeals Coordinator.

1 month ago

Nashville, United States Pyramid Consulting, Inc Full time

Immediate need for a talented Grievance & Appeals Coordinator. This is a 03+months contract opportunity with long-term potential and is located in Nashville, TN(Remote). Please review the job description below and contact me ASAP if you are interested.


Job ID:24-48724

Pay Range:$21 - $22/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:


  • Grievance Coordinator is responsible for corresponding with members, providers and regulators regarding decisions and actions.
  • Works collaboratively with the Claims, Customer Service, Appeals, and Medical Management Departments.
  • Communicate, collaborate and cooperates with internal and external business partners.
  • Adheres to all Compliance/Program Integrity requirements and complies with HIPAA Regulations.
  • Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency.
  • Supports department-based goals which contribute to the success of the organization


Key Requirements and Technology Experience:


  • Key Skills: Grievance & Appeals, Health Insurance, Medicare or Medicaid.
  • Written communication
  • Critical Thinking
  • Microsoft Office Knowledge
  • Minimium requirement: 1 year of G&A and/or 1+ year or more of Customer Service at a health insurance company
  • Bilingual in Spanish is preferred but not required
  • Strong written and verbal communication skills, PC proficiency to include Microsoft office products.
  • One year of health insurance/managed care experience performing Appeals and Grievances functions.
  • Will consider managed care associates with three years of experience in customer service, call center or claims processing skills and knowledge of healthcare delivery.
  • Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment.
  • Demonstrated written communication skills, time management, priority setting, problem solving and organizational skills.
  • Demonstrated ability to converse with and collaborate with physicians and physician personnel.
  • Ability to identify and define problems, collect data/information, establish facts, and draw valid conclusions and provide resolution.
  • Ability to track and manage case load effectively in Grievance tracking system
  • Must be able to work independently and under pressure related to tight time-frames
  • One year of health insurance/managed care experience knowledge of healthcare terminology preferable.
  • Intermediate PC Skills
  • Previous experience working in a remote setting is preferred
  • A high school diploma and two years in a Medicare, Medicaid managed care environment investigating and resolving Grievances


Our client is a leading Insurance Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.


Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, colour, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.


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