Appeals & Grievances Specialist I

MedImpact Healthcare Systems; San Diego (CA); On-site; USD 25,000 - 38,000; Full time

Job summary

MedImpact Healthcare Systems is seeking an Appeals and Grievances Coordinator I to manage appeals and grievances processing with accuracy and timeliness. You will use systems like MedAccess, MedResponse, FileNet and RightFax to perform data entry and analysis under supervision.

The role requires strong customer service skills, confidentiality, and ability to multitask, including weekend shifts. Prior experience in appeals/grievances is beneficial, with a non-exempt status in the United States.

Qualifications

• GED/HS Diploma and 1+ year experience or equivalent combination of education and experience.

Responsibilities

• Evaluate and process Appeals and Grievances per established work instructions and approved departmental documents.
• Perform and document outreach activities (outbound calls/faxes) to obtain information for processing Appeals and Grievances or communicate results.
• Ensure Appeals and Grievances are finalized within the required turnaround time (TAT) per laws and company policies.
• Cross-train across the appeal and grievance task divisions.
• Participate in rotating weekend on-call schedule as needed.
• Protect confidentiality and privacy of members' health information per federal requirements and company policies.

Education

GED/HS Diploma and 1+ year experience or equivalent combination of education and experience

Tools

MS Office

Job description

MedImpact Healthcare Systems is seeking an Appeals and Grievances Coordinator I to manage appeals and grievances processing with accuracy and timeliness. You will use systems like MedAccess, MedResponse, FileNet and RightFax to perform data entry and analysis under supervision.

The role requires strong customer service skills, confidentiality, and ability to multitask, including weekend shifts. Prior experience in appeals/grievances is beneficial, with a non-exempt status in the United States.