Grievance and Appeals Coordinator

6 days ago

Mason, Ohio, United States IntelliPro Group Inc. Full time

About IntelliPro Group Inc.

We are a dynamic company dedicated to delivering high-quality services to our clients. Our mission is to provide exceptional support and expertise to ensure the best possible outcomes for our clients.

Job Description

This role involves serving as a liaison between providers and members, ensuring that issues are resolved efficiently and effectively. The successful candidate will have experience in grievance and appeals, preferably in a managed vision care or insurance setting.

Main Responsibilities:

  • Responsible for investigating and resolving member and provider complaints and grievances.
  • Collaborate with other departments, including Member Services, Claims, and Legal, to resolve issues.
  • Conduct research and secure required information, including member records and claims analysis.
  • Log, track, and process complaints and grievances forwarded to the Quality Assurance Department.
  • Report on key performance indicators (KPIs) for the department.
  • Maintain accurate and complete complaint/grievance records in the electronic database.
  • Coordinate Complaint Sub Committee meetings, including preparing agendas, notifying participants, and maintaining minutes.
  • Meet established quality and productivity standards in all areas of complaints and grievances.
What We Offer

In addition to a competitive salary, we offer a range of benefits, including opportunities for professional growth and development, a dynamic work environment, and a chance to make a real difference in people's lives.

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