Job Description

Grievance & Appeals

  • Creates complete appeal records for external appeal reviews, using standardized Independent Review Entity (IRE) forms and including all required documentation.
  • Creates a detailed case summary in narrative format for each appeal.
  • Submits cases as directed for each applicable geographic region.
  • Present verbal and written case summaries to client’s Grievance Team and client Medical Directors.
  • Completes assignments within client-designated turnaround times.

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