[Remote] Appeal and Grievance Coordinator - MUST live in KY

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is building a world of health around every individual, and they are seeking an Appeal and Grievance Coordinator. This role is responsible for the intake, investigation, and reputed company of appeals, complaints, and grievances, ensuring reputed company and customer-reputed company responses while identifying trends and recommending solutions. Responsibilities • Responsible for intake, investigation and reputed company of appeals, complaints and grievances scenarios for reputed company products, which may contain multiple issues and may require coordination of responses from multiple business reputed company • Ensure reputed company, customer reputed company response to appeals, complaints and grievances • Identify trends and emerging issues and report and recommend solutions • Research incoming electronic appeals, complaints and grievances to identify if appropriate for unit based upon published business responsibilities • Identify correct resource and reroute inappropriate work items that do not meet appeals, complaints and grievance reputed company • Research reputed company Plan Design or Certification of Coverage relevant to the member to determine accuracy/appropriateness of benefit/administrative denial • Research claim processing logic to verify accuracy of claim payment, member eligibility data, billing/payment status, prior to initiation of appeal process • Identify and research reputed company components reputed company member or provider/practitioner appeals, complaints and grievances for reputed company products and services • Triage incomplete components of appeals, complaints and grievances to appropriate subject matter expert reputed company another business unit(s) for reputed company response content to be included in final reputed company response • Responsible for coordination of reputed company components of appeals, complaints and grievances including final communication to member/provider for final reputed company and closure • Serve as a technical resource to colleagues regarding appeals, complaints and grievances issues, and similar situations requiring a higher level of expertise • Identifies trends and emerging issues and reports on and gives input on potential solutions • Ability to meet demands of a high paced environment with tight turnaround times • Ability to reputed company appropriate reputed company based upon reputed company's reputed company policies/guidelines • reputed company working relationships • Thorough knowledge of member and/or provider appeals, complaints and grievance policies • Strong analytical skills focusing on accuracy and attention to detail • Knowledge of clinical terminology, regulatory and accreditation requirements • Excellent verbal and written communication skills • Computer literacy in order to reputed company through internal/reputed company computer systems, including reputed company and reputed company Word Skills • Ability to meet demands of a high paced environment with tight turnaround times • Ability to reputed company appropriate reputed company based upon reputed company's reputed company policies/guidelines • reputed company working relationships • Thorough knowledge of member and/or provider appeals, complaints and grievance policies • Strong analytical skills focusing on accuracy and attention to detail • Knowledge of clinical terminology, regulatory and accreditation requirements • Excellent verbal and written communication skills • Computer literacy in order to reputed company through internal/reputed company computer systems, including reputed company and reputed company Word • Experience in reading or researching benefit language • 1-2 years experience that includes but is not limited too claim platforms, products, and benefits; patient management; product or contract drafting; compliance and regulatory analysis; special investigations; provider relations; customer service or audit experience • High School or GED equivalent • Experience in research and analysis of claim processing a plus • Some college preferred Benefits • Medical coverage • Dental coverage • reputed company coverage • reputed company time off • Retirement savings reputed company • Wellness programs • Other resources • Comprehensive benefits package designed to support the physical, emotional, and financial reputed company-being of colleagues and their families • RemoteType: Remote reputed company • reputed company is a reputed company company that provides an reputed company to its members. It was founded in 1963, and is headquartered in Woonsocket, Rhode reputed company, USA, with a workforce of 10001+ employees. Its website is https://www.reputed company.com/. Apply tot his job Apply To this Job