Grievance & Appeals Coordinator
Elevance Health

Job Info

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Title: Grievance & Appeals Coordinator

Location: This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our PulsePoint locations.

The Grievance & Appeals Coordinator is responsible for investigating and reviewing customer grievances and appeals regarding provision of service and benefit coverage issues. Triages clinical and non-clinical inquiries, grievances and appeals, prepares case files for member grievance committees/hearings.

How you will make an impact:

• Summarizes and presents essential information for the clinical specialist or medical/dental director and legal counsel.
• Responds to oral and written complaints sent to the Office of the Chairman, President or Vice President complaints.
• Ensures appropriate resolution to inquiries, grievances and appeals within specified timeframes established by either regulatory/accreditation agencies or customer needs.
• Contacts members to gather information and communicate disposition of case; documents interactions.
• Generates written correspondence to members, providers and regulatory agencies.
• Identifies barriers to customer satisfaction and recommends actions to address operational challenges.
• Pursues ongoing education/training on benefits/services to ensure accurate resolution of grievances and appeals, and overall industry knowledge and development (i.e. HIAA, LOMA, etc.).
• Operates a PC/image station to obtain and extract information; documents information, activities and changes in the database.

Minimum Requirements

• Requires a HS Diploma or equivalent and 4 years progressively complex experience working in grievances and appeals; or any combination of education and experience which would provide an equivalent background.

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