Grievance/Appeals Representative / Cerritos CA 90703, USA

Mindlance; Cerritos (CA); On-site; USD 40,000 - 55,000; Full time

Job summary

A national recruiting company is seeking a Business Grievance/Appeals Representative in Cerritos, California. The ideal candidate will review, analyze, and process claims, conduct investigations into customer grievances, and ensure proper communication with customers. Candidates should have a high school diploma and relevant customer service experience in health insurance. Successful applicants will possess strong written and verbal communication skills, and be capable of handling complex inquiries. This contract position lasts for four months.

Qualifications

• 1-3 years of experience in health insurance business including customer service.
• Fully proficient in claims and customer service processes.

Responsibilities

• Review, analyze, and process claims in accordance with policies.
• Conduct investigations of customer grievances and appeals.
• Generate written correspondence to customers and regulatory agencies.
• Document interactions and log inquiry/appeal/grievance information.

Skills

Verbal communication

Written communication

Organizational skills

Interpersonal skills

Education

High school diploma or equivalent

Job description

• Contract

Company Description

Mindlance is a national recruiting company which partners with many of the leading employers across the country. Feel free to check us out at http://www.mindlance.com.

Job Description

Business Grievance/Appeals Representative

Contract 4 Months

Qualifications

SUMMARY

· Reviews, analyzes and processes claims in accordance with policies and claims events to determine the extent of the company's liability and entitlement.

MAJOR JOB DUTIES AND RESPONSIBILITIES

· Conducts investigation and review of customer grievances and appeals involving provision of service and benefit coverage issues.

· Contacts customers to gather information and communicate disposition of case; documents interactions.

· Generates written correspondence to customers such as members, providers and regulatory agencies.

· Performs research to respond to inquiries and interprets policy provisions to determine the extent of company's liability and/or provider's/beneficiaries entitlement.

· Responds to appeals from CS Units, Provider Inquiry Units, members, providers and/or others for resolution or affirmation of previously processed claims.

· Ensures appropriate resolution to inquiries, grievances and appeals within specified timeframes established by either regulatory/accreditation agencies or customer needs.

· Triages clinical and non-clinical inquiries, grievances and appeals, prepares case files for member grievance committees/hearings.

· Summarizes and presents essential information for the clinical specialist or medical director and legal counsel.

· Responds to oral and written complaints sent to the Office of the Chairman, President or Vice President Complaints.

· Identifies barriers to customer satisfaction and recommends actions to address operational challenges.

· Thoroughly documents and logs inquiry/appeal/grievance information on Grievance and Appeal Tracking systems for accurate tracking and analysis.

· Good verbal and written communication, organizational and interpersonal skills.

EDUCATION/EXPERIENCE

· High school diploma or equivalent required.

· 1 - 3 years health insurance business including customer service experience required.

· Fully proficient in all areas of claims and customer service; may need guidance and supervision to complete some functions.

If you are available and interested then please reply me with your “Chronological Resume” and call me on (678)-405-3590 .

Additional Information

Thanks & Regards,