Healthcare

Grievance and Appeals Coordinator

Contract

Strategic Staffing Solutions

STRATEGIC STAFFING SOLUTIONS (S3) HAS AN OPENING!

Strategic Staffing Solutions is currently looking for a Grievance and Appeals Coordinator for a contract opportunity with one of our largest clients located in Detroit, MI!

Title: Grievance and Appeals Coordinator

Location: Detroit, MI (Remote/local to Michigan)

Role Type: W2 potential to convert to FTE

Engagement Description

  • 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.
  • Coordinate, facilitate, and conduct managerial level conferences with customers and their authorized representatives to gather and relay information.
  • 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 timeframes, accuracy and response guidelines.
  • Responsible for staying abreast of products, networks, internal policies, procedures and regulations for the accurate resolution of appeals, complaints, grievances, and inquiries.

Top Required Skills/Experience

  • Excellent written and verbal communication skills.
  • Must be proficient in proofreading, spelling, grammar, punctuation, and math.
  • Previous customer service or concierge experience.
  • Strong PC application and system skills- having the ability to navigate multiple computer systems and databases.

Required Skills/Experience

  • Analytical mindset- having the ability to examine a matter, the facts, contextual information and make an informed decision or implement a reasonable, rationale solution.
  • Ability to apply policies and procedures to arrive at accurate conclusions.
  • Ability to analyze, interpret, apply reason and logic, conduct research; structure a clear and thorough response.
  • Ability to work in a fast-paced environment with tight deadlines and high quality standards
  • Problem solving aptitude.
  • Accuracy and strong attention to detail.
  • Ability to prioritize responsibilities and effectively manage time.
  • Ability to work effectively with management and part of a team to meet targets.
  • High regard for protecting confidentiality of member, employee, corporate and performance information.

Preferred Skills/Experience

  • Previous health care or health insurance industry experience.

Education

  • Bachelor’s Degree in English, Communication, Health Care Administration, or related field.

The S3 Difference

The global mission of S3 is to build trusting relationships and deliver solutions that positively impact our customers, our consultants, and our communities.  The four pillars of our company are to:

  • Set the bar high for what a company should do
  • Create jobs
  • Offer people an opportunity to succeed and change their station in life
  • Improve the communities where we live and work through volunteering and charitable giving

As an S3 employee, you’re eligible for a full benefits package that may include:

  • Medical Insurance
  • Dental Insurance
  • Vision Insurance
  • 401(k) Plan
  • Vacation Package
  • Life & Disability Insurance Plans
  • Flexible Spending Accounts
  • Tuition Reimbursement

Job ID: JOB-209248
Publish Date: 10 Nov 2022

Tagged as: Grievance and Appeals Coordinator