Insurance

Grievance & Appeals Coordinator

Contract

Strategic Staffing Solutions

STRATEGIC STAFFING SOLUTIONS HAS AN OPENING!

Strategic Staffing Solutions (S3) is currently looking for a Grievance & Appeals Coordinator for a contract opening with one of our largest clients located in Detroit, MI

Role Title: Grievance & Appeals Coordinator

Location:  Detroit, MI (Fully Remote in EST)

Duration: 7+ months (Possible conversion to LTC or FTE)

Role Type: W2 Contract Engagement

Pay Rate: $30-32/hour

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.
  • 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:

  • Ability to apply policies and procedures to arrive at accurate conclusions.
  • Ability to analyze, interpret, apply reason and logic, and conduct research to 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.
  • Previous customer service or concierge experience.

Preferred Skills/Experience:

  • Previous health care or health insurance industry experience.

Education/Certifications:

  • 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-233620
Publish Date: 22 Jan 2024

Tagged as: Grievance & Appeals Coordinator