Remote Grievance & Appeals Specialist

TEKsystems; Columbus (OH); On-site; USD 26,000 - 37,000; Full time

Benefits offered by this job

Medical, dental & vision

401(k) Retirement Plan

Paid time off

Job summary

TEKsystems is seeking a Contract Grievances and Appeals Specialist for a fully remote role based out of Columbus, OH. The position analyzes and resolves verbal and written claims and appeals from providers and members, and prepares response letters.

This is a contract position with a $23/hour pay rate. Ideal candidates have a high school diploma (associate's degree preferred) and 2+ years of managed care grievance/appeals experience, plus strong oral and written communication and problem-solving

Qualifications

• 2+ years grievance or appeals, claims or related managed care experience.
• High school diploma or equivalent; associate's degree preferred.
• Strong oral, written, and problem-solving skills.

Responsibilities

• Gather, analyze and report verbal and written member and provider complaints, grievances and appeals
• Prepare response letters for member and provider complaints, grievances and appeals
• Maintain files on individual appeals and grievances
• May coordinate the Grievance and Appeals Committee
• Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information
• Assist with HEDIS production functions including data entry, calls to provider's offices, and claims research.
• Manage large volumes of documents including copying, faxing and scanning incoming mail

Skills

Grievances & Appeals

Communication skills

Education

High School Diploma

Associate's degree preferred

Job description

TEKsystems is seeking a Contract Grievances and Appeals Specialist for a fully remote role based out of Columbus, OH. The position analyzes and resolves verbal and written claims and appeals from providers and members, and prepares response letters.

This is a contract position with a $23/hour pay rate. Ideal candidates have a high school diploma (associate's degree preferred) and 2+ years of managed care grievance/appeals experience, plus strong oral and written communication and problem-solving