Appeals and Grievances Specialist II

The Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member and provider complaints and appeals exercising strong independent judgment.

Requirements

• Identifies, investigates, and resolves administrative complaints, complex provider appeals and State Fair Hearing adhering to CMS, DHCS, DMHC, MRMIB and NCQA standards and regulations.
• Ensures integrity of A&G database by thorough, timely and accurate assignment of cases.
• Prepare and analyze monthly appeal and grievance reports to meet internal and external reporting requirements.

Benefits

• Paid Time Off (PTO)
• Tuition Reimbursement
• Retirement Plans
• Medical, Dental and Vision
• Wellness Program
• Volunteer Time Off (VTO)