Description: Judge Healthcare is currently seeking a Grievance Resolution Specialist in Orange County, CA!
Below you can find a basic overview of the position. For additional information or for any questions, please reach out to Jacob at jmaybrier@judge.com
Schedule: Monday-Friday, 8am-5pm (on-site)
This job will have the following responsibilities:
Maintains adequate information in clients Health's systems; ensures data collection, summarization, integration, and reporting which includes case creation and management and events/activity tracking.
Gathers pertinent information regarding the grievances and appeals received, including, but not limited to, member or provider concerns, supporting information related to initial decision-making, new information supporting the grievance or appeal, or supplemental information required to evaluate grievances and appeals within regulatory requirements.
Evaluates case details, proposes recommendations, or makes decisions as applicable; ensures organization decision is implemented according to the Grievance and Appeals policies and case resolution.
Develops resolution letters and correspondence to members and providers
Qualifications & Requirements:
High School diploma or equivalent required.
1 year of experience in any of the following areas: Grievances and Appeals, Claims, Regulatory Compliance, Customer Service, or related fields required.
Again, For additional information or for any questions, please reach out to Jacob at jmaybrier@judge.com
Thank You,
Jacob
Contact: jmaybrier@judge.com
This job and many more are available through The Judge Group. Find us on the web at www.judge.com
