Appeals and Grievances Representative, Advanced
1 day ago
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
Your Knowledge and Experience Requires a high school diploma or GEDRequires 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 combinationExperience with Appeals and Grievances Intake process preferred General knowledge of applicable legislation/regulations and complianceBasic 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
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El Dorado Hills, United States Blue Shield of California Full timeYour 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...
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