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Grv/Appeals Associate-25050-1 MPK

Monterey Park, California | Contract

Job ID: 55360 Position: Administrative/Clerical/Support Branch: Torrance

EXCITING CONTRACT POSITION IN MONTEREY PARK FOR MEMBER REIMBURSEMENT COORDINATOR!

 

JOB DUTIES:

Researches and resolves member/subscriber grievances, appeals and complaints, and interprets and explains 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. Identifies issues, and with assistance, executes corrective action Intake Queue. Complaint files Process QOC files. EID -Expedited Initial Determinations Performs established performance metrics

REQUIREMENTS:

1 year of experience within claims or utilization management

Strong MS Office including data entry and calendaring

 

Working knowledge of ICD10-CM, HCPCS and CPT codes

Rachel Savitt
Staffing Manager

Rachel rejoined the Wollborg Michelson Recruiting team in Torrance as the Staffing Manager. She previously worked for the company from 2006-2009 as a Recruiter for the Temporary division. Rachel brings over 16 years of Staffing Industry experience. She has worked on all sides of the industry as a temporary employee, client, full desk Recruiter as well as corporate for a Staffing Company. Her goal is to change the lives of everyone she works with no matter what their role. In her free time, Rachel enjoys spending time with her friends and family. She is active with multiple non-profit animal rescues and prefers to ask for donations instead of gifts for birthday. She also enjoys kickboxing, Muay Thai and dancing. Rachel always finds a way to connect with people. Her #1 Strength from Strengthfinders is Connectedness.

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