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Grievance and Appeals Specialist

Company: Kforce Finance and Accounting
Location: Orange
Posted on: March 19, 2023

Job Description:

Kforce client is seeking a Bilingual Grievance and Appeals Specialist. This position will be onsite in Orange, CA.

Responsibilities include:

  • In this role, the Grievance and Appeals Specialist will coordinate the Grievance and Appeal resolution process, respond to verbal and written
  • Grievances and Appeals from members and/or providers relating to member eligibility and benefits, contract administration, claims processing, utilization management decisions, and pharmacy and vision decisions
  • Frequent external contact with members and families, healthcare providers, health networks, third-party administrators, and regulators
  • The Grievance and Appeals Specialist will collaborate with internal departments such as Customer Service, Provider Operations, Pharmacy, and Medical Management to identify factors necessary for the optimal resolution of Grievances and Appeals
  • Accurate data collection of concerns and supporting documentation
  • Create resolution letters and correspondence to members and providers

Keywords: Kforce Finance and Accounting, Orange , Grievance and Appeals Specialist, Other , Orange, California

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