Job Description
Job Title: Grievances and Appeals Coordinator
Job Description
The Grievances and Appeals Coordinator analyzes and resolves verbal and written claims, authorizations, complaints, grievances, and appeals from members and providers in a regulated healthcare environment. This role ensures timely, accurate, and compliant resolution of cases, supports performance and quality programs, and contributes to continuous improvement in member and provider experience through strong communication, documentation, and analytical skills.
Responsibilities
+ Analyze and resolve verbal and written claims, authorization appeals, complaints, grievances, and appeals from members and providers.
+ Gather, analyze, and report data related to member and provider complaints, grievances, and appeals to support compliance and quality standards.
+ Prepare clear, professional response letters addressing member and provider complaints, grievances, and appeals.
+ Complete cas...
Job Description
The Grievances and Appeals Coordinator analyzes and resolves verbal and written claims, authorizations, complaints, grievances, and appeals from members and providers in a regulated healthcare environment. This role ensures timely, accurate, and compliant resolution of cases, supports performance and quality programs, and contributes to continuous improvement in member and provider experience through strong communication, documentation, and analytical skills.
Responsibilities
+ Analyze and resolve verbal and written claims, authorization appeals, complaints, grievances, and appeals from members and providers.
+ Gather, analyze, and report data related to member and provider complaints, grievances, and appeals to support compliance and quality standards.
+ Prepare clear, professional response letters addressing member and provider complaints, grievances, and appeals.
+ Complete cas...
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