Title: Grievance &Appeals Coordinator
Work Location: Detroit, MI, 48226
Duration: 6 Months
Job Type: Contract
Work Type: Remote
Pay Rate: $22.00 - $24.00/hr. on W2
Overview:
TekWissen is a global workforce management provider headquartered in Ann Arbor, Michigan that offers strategic talent solutions to our clients world-wide. Our client is a health insurance company. It offers different types of health care coverage plans that include individual and family, dental and vision, plans for employers, etc.
Engagement Description:
- Process appeals and grievances, analyse, research, and provide comprehensive responses in accordance with established regulatory and accreditation guidelines.
- Contact customers to gather information and communicate disposition of case.
- Conduct pertinent research in order to evaluate, respond to, and finalize case.
- Familiar with standard concepts, practices, and procedures for analysing, interpreting data and applying contract and regulatory provisions.
- High School Diploma or GED required.
- Bachelor's Degree in English, Communications or related field preferred.
- Two (2) years customer service experience required.
- Two (2) years health insurance experience and familiarity with health insurance state and federal regulations preferred.
- Strong project management skills preferred.
Top 3 Required Skills/Experience -
- Experience handling a large load of work in a fast-paced environment and have computer skills.
- Insurance, Medicare/CMS knowledge
- Customer Service Experience
Required Skills/Experience - The rest of the required skills/experience. Include:
- Writing Letters
- Analytical thinker
- Research Skills
- Multi-task
Preferred Skills/Experience - Optional but preferred skills/experience. Include:
- Grievance and Appeals experience.
- Degree in Healthcare/computer skills
- Experience in analyzing a claim
- Experience in classification between a grievance/appeal/organizational determination.
- Letter writing
- Basic computer skills. How to save a PDF, how to navigate excel, learning new systems
Education/Certifications - Include:
TekWissen Group is an equal opportunity employer supporting workforce diversity.