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Appeals & Grievance Specialist - Commercial Plans
JOB SUMMARYThe Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider complaints, appeals and grievance cases for products for all lines of business. Responsibilities include, but are not limited to: timely classification and resolution of cases; review, research and coordination of complaints, grievances, appeals and reconsiderations consistent with statutory and federal regulatory guidelines.ESSENTIAL FUNCTIONS OF THE ROLEMaintains data entry requirements for all complaints, appeals and grievances.Builds case files for each complaint, appeal and grievance, and ensures compliance with organizational and regulatory guidelines.
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