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Grievance and Appeals Specialist

1 month ago

Detroit, Michigan, United States Strategic Staffing Solutions Full time

Job Summary:

Strategic Staffing Solutions is seeking a highly skilled Grievance and Appeals Coordinator to join our team. As a key member of our team, you will be responsible for processing grievances and organization determinations, analyzing and researching data, and providing comprehensive responses in accordance with established regulatory and accreditation guidelines.

Key Responsibilities:

  • Process grievances and organization determinations, analyzing and researching data to provide comprehensive responses.
  • Contact customers to gather information and communicate disposition of case.
  • Conduct pertinent research to evaluate, respond to, and finalize case.
  • Familiar with standard concepts, practices, and procedures for analyzing, interpreting data, and applying contract and regulatory provisions.

Requirements:

  • Bachelor's Degree in Health Care Administration, English, Communications, or related field preferred.
  • Two (2) years customer service experience required.
  • Two (2) years health insurance experience and familiarity with health insurance state and federal regulations preferred.
  • Strong project management skills preferred, including management of personal inventory.
  • Strong analytical, critical thinking, organizational, time management, and problem resolution skills.
  • Excellent verbal and written communication skills.
  • Strong PC applications, including Microsoft Excel, Word, and Outlook.
  • High regard for protecting confidentiality of corporate information.
  • Proven ability to foster and maintain open, collaborative, and constructive relationships within internal, external, and leadership to achieve departmental and corporate results.
  • Ability to apply policies and procedures to arrive at accurate conclusions.
  • Ability to analyze, interpret, apply reason and logic, conduct research, structure a clear and thorough response.
  • Ability to quickly learn and navigate diverse products and information systems.
  • An understanding of MA servicing structure related to grievance and appeals or experience in claims with the ability to apply EOC research in prepping cases preferred.
  • Previous experience with Health Insurance preferred.
  • Demonstrates ability to handle multiple tasks/projects concurrently with minimal supervision.

What We Offer:

  • Medical Insurance
  • Dental Insurance
  • Vision Insurance
  • 401(k) Plan
  • Vacation Package
  • Life & Disability Insurance Plans
  • Flexible Spending Accounts
  • Tuition Reimbursement

About Us:

Strategic Staffing Solutions is a global company that builds trusting relationships and delivers solutions that positively impact our customers, consultants, and communities. Our four pillars are to set the bar high for what a company should do, create jobs, offer people an opportunity to succeed and change their station in life, and improve the communities where we live and work through volunteering and charitable giving.