EmblemHealth
Grievance & Appeals Specialist
This job is now closed
Job Description
- Req#: 5962
Employer Industry: Healthcare Insurance
Why Consider this Job Opportunity:
- Competitive pay up to $77,000
- Opportunity for career advancement and growth within the organization
- Supportive and collaborative work environment
- Chance to make a positive impact on member and provider relations
- Excellent benefits package, including healthcare coverage and retirement plans
- Opportunity to work in a regulated industry and ensure compliance with all regulatory requirements
What to Expect (Job Responsibilities):
- Review and evaluate appeal and grievance requests to identify and classify member and provider appeals
- Provide written acknowledgment of member and provider correspondence
- Conduct thorough investigations of all member and provider correspondence
- Serve as a liaison with internal departments and external entities to ensure timely resolution of cases
- Prepare cases for medical and administrative review and accurately document findings
What is Required (Qualifications):
- Associate Degree in a related field; Bachelor's preferred
- 3+ years of related professional work experience required
- Excellent verbal and written communication skills required
- Proficiency in MS Office applications required
- Excellent problem-solving and analytical skills required
How to Stand Out (Preferred Qualifications):
- Customer service experience preferred
- Excellent product knowledge preferred
- Prior health industry and/or compliance work experience preferred
#HealthcareInsurance #CareerOpportunity #CompetitivePay #RegulatoryCompliance #CustomerService
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We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.About the company
EmblemHealth provides all our members the latest plan & health information, including GHI Insurance information. We are dedicated to helping you stay healthy, get well, and live better.
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