Grievance and Appeal Coordinator

We're Hiring: Grievance and Appeal Coordinator!

Location: Detroit, MI
Role: Grievance and Appeal Coordinator
Duration: 6 months

The Grievance and Appeals (G&A) Coordinator is responsible for processing appeals, grievances, complaints, and inquiries received from members, authorized representatives, and regulatory agencies. The Coordinator is expected to analyze the customer’s concerns, conduct necessary research by leveraging various internal and external resources and contacts in order to make appropriate and accurate case decisions. Appeal Coordinators are expected to coordinate, facilitate, and conduct managerial-level conferences with customers and their authorized representatives to gather and relay information.

The Coordinator is expected to keep an accurate documentation record that details steps and actions taken to resolve the customer’s concerns. The outcome and resolution of all appeals, grievances, complaints, and inquiries are communicated via written correspondence to the customer using clear and simple language and include elements that satisfy corporate, regulatory, and accreditation time frames, accuracy, and response guidelines.

The Coordinator is responsible for staying abreast of products, networks, internal policies, procedures, and regulations for the accurate resolution of appeals, complaints, grievances, and inquiries.

Top 3 Required Skills/Experience

• Excellent written and verbal communication skills. Must be proficient in proofreading, spelling, grammar, punctuation, and math.
• Analytical mindset – ability to examine a matter, the facts, contextual information, and make an informed decision or implement a reasonable, rational solution.
• Strong PC application and system skills – ability to navigate multiple computer systems and databases.

Education/Certifications

• Bachelor’s Degree in English, Communication, Health Care Administration, or related field.

• Ability to apply policies and procedures to arrive at accurate conclusions.
• Ability to analyze, interpret, apply reason and logic, and conduct research to structure a clear and thorough response.
• Ability to work in a fast-paced environment with tight deadlines and high-quality standards.
• Problem-solving aptitude.
• Accuracy and strong attention to detail.
• Ability to prioritize responsibilities and effectively manage time.
• Ability to work effectively with management and as part of a team to meet targets.
• High regard for protecting confidentiality of member, employee, corporate, and performance information.
• Previous customer service or concierge experience.

Preferred Skills/Experience

• Previous health care or health insurance industry experience.

Ready to make an impact? Apply now and let's grow together!