Member Appeals & Grievances Specialist

Metropolitan Jewish Health System, Inc.; New York (NY); On-site; USD 52,000 - 62,000; Full time

Job summary

The Metropolitan Jewish Health System, Inc. is seeking a coordinator to investigate and respond to written or verbal appeals and grievances from members and providers, ensuring adherence to CMS, DOH, and contract requirements.

You will determine service type, manage timelines, and document cases for review. The role requires strong communication, attention to detail, and the ability to manage multiple tasks while meeting strict deadlines, with preferred an associate degree and 2 years of related

Qualifications

• Associates degree or equivalent preferred.
• 2 years prior related experience.
• Proficient in MS Word and Excel.
• Excellent written and verbal communication skills, attention to detail, ability to set priorities and meet deadlines.

Responsibilities

• Investigate and respond to written or verbal appeals and grievances submitted by members and providers.
• Determine the appropriate type of service, appeal or grievance and respond within time guidelines.
• Present cases for review and document all relevant information.

Skills

Communication skills

Attention to detail

Time management

MS Word

Excel

Education

Associates degree or equivalent

Job description

The Metropolitan Jewish Health System, Inc. is seeking a coordinator to investigate and respond to written or verbal appeals and grievances from members and providers, ensuring adherence to CMS, DOH, and contract requirements.

You will determine service type, manage timelines, and document cases for review. The role requires strong communication, attention to detail, and the ability to manage multiple tasks while meeting strict deadlines, with preferred an associate degree and 2 years of related