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Grievance and Appeals Resolution Specialist

2 months ago

Fairfield California, United States Partnership HealthPlan of California Full time
About the Role

We are seeking a highly skilled and detail-oriented Grievance & Appeals Case Analyst to join our team at Partnership HealthPlan of California. As a key member of our Grievance & Appeals Resolution process, you will play a critical role in ensuring that our members receive the highest level of service and satisfaction.

Key Responsibilities
  • Investigate and resolve member grievances and appeals in a timely and fair manner
  • Review and analyze case information to determine the best course of action
  • Communicate with members, providers, and internal stakeholders to resolve issues
  • Document all case activity thoroughly and accurately
  • Stay up-to-date on changes in healthcare regulations and guidelines
Requirements
  • Bachelor's degree or four years of related work experience
  • Strong analytical and problem-solving skills
  • Excellent communication and interpersonal skills
  • Ability to work independently and as part of a team
  • Knowledge of healthcare regulations and guidelines
What We Offer

We offer a competitive salary and benefits package, as well as opportunities for professional growth and development. If you are a motivated and detail-oriented individual who is passionate about delivering exceptional customer service, we encourage you to apply for this exciting opportunity.