Medicare Grievances & Appeals Specialist

The Jacobson Group; Rhode Island; Hybrid; USD 32,000 - 37,000; Full time

Benefits offered by this job

Medical insurance

Vision insurance

401(k) retirement savings plan

Job summary

The Jacobson Group is seeking a Case Specialist, Grievance and Appeals on a hybrid basis in Rhode Island. You will investigate and resolve member and provider complaints, manage benefits and administrative appeals, and maintain thorough case documentation.

The role requires Medicare experience within a managed care environment and strong communication skills. You will educate members about their plans, collaborate with internal teams on trend analysis and process improvements, and participate in

Qualifications

• 4+ years working with appeals and grievances in a managed care environment.
• Must reside within a commutable distance to Rhode Island and be willing to come into the office as needed.
• Medicare experience with appeals and grievances, customer service or claims.
• Strong written and verbal communication skills.

Responsibilities

• Investigate and resolve member and provider complaints, benefits appeals, and administrative appeals.
• Maintain detailed documentation of cases and follow up as necessary.
• Respond to inquiries via telephone and written communication, providing clear and accurate information.
• Educate members to improve their understanding of their healthcare plans.
• Identify and elevate potential quality of care issues for review.
• Collaborate with internal departments to analyze trends, identify root causes for appeals, and suggest procedural or policy changes.
• Prepare for departmental audits in anticipation of regulatory site visits.

Skills

Communication skills

Medicare experience

Appeals & grievances

Collaboration

Job description

The Jacobson Group is seeking a Case Specialist, Grievance and Appeals on a hybrid basis in Rhode Island. You will investigate and resolve member and provider complaints, manage benefits and administrative appeals, and maintain thorough case documentation.

The role requires Medicare experience within a managed care environment and strong communication skills. You will educate members about their plans, collaborate with internal teams on trend analysis and process improvements, and participate in