Appeals and Grievance Coordinator - Remote Opportunity

About the Role

We are seeking an Appeals and Grievance Coordinator to join our team at Universal Healthcare MSO. This is a fantastic opportunity to work remotely while supporting the end-to-end appeals and grievances process. You will be responsible for managing member and provider complaints and appeals, ensuring timely resolutions, and collaborating with various internal departments.

What You'll Do

• Support the appeals and grievances process by tracking and resolving member and provider complaints.
• Maintain accurate records of appeals and grievances data, ensuring compliance with regulatory requirements.
• Perform administrative duties, including organizing case documentation and monitoring deadlines.
• Engage with members and providers through various communication methods to address inquiries and requests.
• Participate in departmental training and cross-functional workgroups to enhance operational efficiency.

Requirements

• Associate’s degree in health, social services, or a related field preferred.
• One year of experience in a managed healthcare setting or related environment.
• Strong customer service skills and experience interacting with members, patients, and providers.
• Proficiency in Microsoft Office Suite, including Word, Excel, and Outlook.
• Bilingual in English and Spanish is preferred.

Nice to Have

• Experience with conflict resolution techniques.
• Knowledge of healthcare coverage and benefit structures.
• Understanding of medical billing and coordination of benefits.

What We Offer

• Competitive salary ranging from $26.00 to $32.49 per hour, based on experience.
• Comprehensive benefits package including medical, dental, and vision coverage.
• Paid Time Off (PTO) and floating holidays.
• Employer contributions to a Simple IRA plan.
• Employer-paid life insurance and employee assistance programs.