Appeals and Grievances Specialist
5 days ago
We are seeking a highly skilled and detail-oriented Appeals and Grievances Specialist I to join our team. The ideal candidate will have a strong background in managed care and a passion for advocating for patients' rights.
Key Responsibilities:- Manage and resolve appeals and grievances in a timely manner.
- Communicate effectively with members, providers, and internal teams to gather necessary information.
- Interpret and apply regulations related to Medicare, Medi-Cal, and other state-sponsored programs.
- Maintain accurate records and documentation of all interactions and resolutions.
- Work collaboratively with team members to meet firm deadlines and improve processes.
- Education: Associate's degree required; or 3+ years of experience in Appeals & Grievances with excellent writing skills in lieu of a degree.
- Experience:
- Minimum of 1 year of experience in grievances within a call center environment in managed care.
- At least 1 year of experience in managed care, specifically working with Medicare, Medi-Cal, and other state-sponsored programs.
- Must be organized and detail-oriented.
- Ability to exercise strong independent judgment.
- Excellent conflict resolution and persuasion skills.
- Strong advocacy skills and a commitment to patient care.
- Ability to work under pressure and meet deadlines while maintaining attention to detail.
We offer a competitive salary and benefits package, overtime opportunity, hybrid schedule, and great pay up to $68K. Our team is committed to working with and providing reasonable accommodations to individuals with disabilities.
About Us:AppleOne is a leading workforce management company founded by Janice Bryant Howroyd. We are dedicated to keeping the humanity in Human Resources and Strategic, Inclusive Procurement. Our team is passionate about delivering corporate HR initiatives to local and global markets.
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