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Grv/Appeals Associate - (27379-1 MTPK)

Monterey Park, California | Contract

Job ID: 55911 Position: Claims Processor Branch: Rancho Cordova

Wollborg Michelson is supporting a large healthcare organization in Monterey Park and we are currently seeking four Grievance and Appeals Associates. Associate will research  and resolve  member/subscriber grievances, appeals and complaints, and interpret  and explain  health plan benefits, policies and procedures to respondents. Researches, reviews and resolves high level/high priority member grievances, appeals and complaints, while clarifying issues and educating customers in the process. Interprets and explains health plan benefits, policies, procedures and functions to members and providers. Produces complex written correspondence to resolve member grievances, appeals and complaints. Administers ongoing grievance tracking, trending and reporting for assigned grievances. Evaluates all grievances for trend purposes and reports periodic and ad hoc trends to Risk and Quality Management departments. Coordinates next level grievance/appeal meeting with appropriate parties and forwards documentation to the review committee. Establishes and maintains cohesive relationships with assigned IPA partners through telephone, field work and written communication.

Responsibilities

In training (or recently completed), not consistently reaching production/quality standards

Identifies issues, and with assistance, executes corrective action Intake Queue. Complaint files Process QOC files. EID -Expedited Initial Determinations Performs established performance metrics

Education/Requirements

In the process of developing specific skills needed to perform non-routine tasks General knowledge of applicable legislation/regulations and actively maintains compliance

Minimum Experience Level

Typically 0-1 year of related experience

Allyn Friedrichsen
Branch Manager

Allyn has a proven track record as an industry leader and excels in building great relationships with both her clients and candidates. She is committed to true partnership, and is so passionate about finding the next dream job for her candidates and building cohesive teams for her business partners. Outside of work, Allyn enjoys spending time with her family, watching the San Francisco Giants games, being outdoors, reading and listening to country music.

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