Appeal and Grievance Coordinator - MUST live in LA

The Appeal and Grievance Coordinator will be responsible for intake, investigation, and resolution of appeals, complaints, and grievances for all products. The role requires a high level of expertise and analytical skills, as well as strong communication and collaboration skills.

Requirements

• Research incoming electronic appeals, complaints, and grievance to identify if appropriate for unit based upon published business responsibilities.
• Research Standard Plan Design or Certification of Coverage relevant to the member to determine accuracy/appropriateness of benefit/administrative denial.
• Research claim processing logic to verify accuracy of claim payment, member eligibility data, billing/payment status, prior to initiation of appeal process.

Benefits

• Affordable medical plan options
• 401(k) plan with matching company contributions
• Employee stock purchase plan
• Wellness screenings
• Tobacco cessation and weight management programs
• Confidential counseling and financial coaching
• Paid time off
• Flexible work schedules
• Family leave
• Dependent care resources
• Colleague assistance programs
• Tuition assistance
• Retiree medical access