Grievance and Appeals Specialist

3 weeks ago


Hamtramck, Michigan, United States GTECH Corporation Full time
Job Summary

We are seeking a highly skilled Grievance and Appeals Coordinator to join our team at GTECH Corporation. As a key member of our team, you will be responsible for processing appeals and grievances, analyzing data, and providing comprehensive responses in accordance with established regulatory and accreditation guidelines.

Key Responsibilities
  • Process appeals and grievances in a timely and efficient manner
  • Analyze data to identify trends and areas for improvement
  • Provide comprehensive responses to appeals and grievances, ensuring compliance with regulatory and accreditation guidelines
  • Communicate with customers to gather information and provide updates on case disposition
  • Conduct research to evaluate and respond to appeals and grievances
Requirements
  • High School Diploma or GED required; Bachelor's Degree in English, Communications, or related field preferred
  • Two years of customer service experience required; two years of health insurance experience and familiarity with state and federal regulations preferred
  • Strong project management skills and ability to handle a large workload in a fast-paced environment
  • Excellent analytical and research skills, with ability to interpret data and apply contract and regulatory provisions
Preferred Skills
  • Grievance and Appeals experience
  • Degree in Healthcare
  • Experience in analyzing claims and classifying grievances/appeals/organizational determinations
Education/Certifications
  • Healthcare, English


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