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Grievance &Appeals Coordinator

TekWissen LLC
locationDetroit, MI, USA
PublishedPublished: 6/14/2022
Legal
Full Time

Job Description

Job DescriptionOverview: TekWissen is a global workforce management provider headquartered in Ann Arbor, Michigan that offers strategic talent solutions to our clients world-wide. Our client is a health insurance company. It offers different types of health care coverage plans that include individual and family, dental and vision, plans for employers, etc. Title: Grievance &Appeals CoordinatorWork Location: Detroit, MI, 48226Duration: 6 Months Job Type: ContractWork Type: RemoteDept: 126160Engagement Description:

  • Process appeals and grievances, analyse, research, and provide comprehensive responses in accordance with established regulatory and accreditation guidelines.
  • Contact customers to gather information and communicate disposition of case.
  • Conduct pertinent research in order to evaluate, respond to, and finalize case.
  • Familiar with standard concepts, practices, and procedures for analysing, interpreting data and applying contract and regulatory provisions.
  • High School Diploma or GED required.
  • Bachelor's Degree in English, Communications or related field preferred.
  • Two (2) years customer service experience required.
  • Two (2) years health insurance experience and familiarity with health insurance state and federal regulations preferred.
  • Strong project management skills preferred.

Top 3 Required Skills/Experience

  • Experience handling a large load of work in a fast-paced environment and have computer skills!
  • Insurance, Medicare/CMS knowledge
  • Customer Service Experience

Required Skills/Experience The rest of the required skills/experience. Include:

  • Writing Letters
  • Analytical thinker
  • Research Skills
  • Multi-task

Preferred Skills/Experience Optional but preferred skills/experience. Include:

  • Grievance and Appeals experience.
  • Degree in Healthcare/computer skills
  • Experience in analyzing a claim
  • Experience in classification between a grievance/appeal/organizational determination.
  • Letter writing
  • Basic computer skills. How to save a PDF, how to navigate excel, learning new systems

Education/Certifications Include:

  • Healthcare, English

TekWissen Group is an equal opportunity employer supporting workforce diversity.

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