Grievance and Appeals Coordinator

The Grievance and Appeals (G&A) Coordinator is responsible for processing appeals, grievances, complaints, and inquiries received from members, authorized representatives, and regulatory agencies. The Coordinator is expected to analyze the customer’s concerns, conduct necessary research by leveraging various internal and external resources and contacts in order to make appropriate and accurate case decisions. Appeal Coordinators are expected to coordinate, facilitate, and conduct managerial level conferences with customers and their authorized representatives to gather and relay information. The Coordinator is expected to keep an accurate documentation record that details steps and action taken to resolve the customer’s concerns. The outcome and resolution of all appeals, grievances, complaints, and inquiries is communicated via written correspondence to the customer using clear and simple language and include elements that satisfy corporate, regulatory, and accreditation time frames, accuracy, and response guidelines. The Coordinator is responsible for staying abreast of products, networks, internal policies, procedures and regulations for the accurate resolution of appeals, complaints, grievances, and inquiries.

Top 3 Required Skills/Experience –

• Excellent written and verbal communication skills. Must be proficient in proofreading, spelling, grammar, punctuation, and math.

• Analytical mindset- having the ability to examine a matter, the facts, contextual information and make an informed decision or implement a reasonable, rationale solution.

• Strong PC application and system skills- having the ability to navigate multiple computer systems and databases.

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

• Ability to apply policies and procedures to arrive at accurate conclusions.

• Ability to...