Job Description
• Research and resolve member complaints for all lines of business ensuring compliance with Grievance and Appeals policies and procedures.
• Maintain grievance and appeals case files in the database.
• Effectively communicate with members and providers verbally and in writing.
• Prepare summaries and write resolution letters for members, which includes summarizing member complaints and steps taken to resolve complaints in clear and grammatically correct language.
• Attend and present cases at bi-weekly Staff Grievance and Appeals Committee.
• Prepare files for appeals to regulatory agencies.
• Maintain current on all regulatory requirements as they apply to grievance and appeal processes.
Qualifications
• Must have excellent writing (drafting, editing, and summaries/compositions).
• Strong customer services skills (both in person and telephonic).
• Ability to problem solve, critical thinking, attention to detail, and stay organized.
• General knowledge of Microsoft Office Applications.
• Do NOT have to have Grievance and Appeals experience, but must have the willingness to learn
Additional Information
Hours for this Position: Monday through Friday between 7.30am and 5pm; can choose any variation of an 8 hour workday
Advantages of this Opportunity:
• Competitive salary of $20-25/hour, negotiable based on relevant experience
• Benefits offered, Medical, Dental, and Vision
• Fun and positive work environment
Want to be considered?
If you are interested in applying to this position, please contact Jessica MacDonell and click the Green I’m Interested Button to email your resume.
Company Description
HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!