The APPEALS & GRIEVANCES SPECIALIST is responsible for processing member grievances, appeals and coverage determinations. This position also provides training to call center representatives on the appeals and grievances processes.
•High School Diploma
•Minimum two years’ experience in managed care/health care customer service and/or Medicare appeals and grievances
•Advanced knowledge of MS Office
•Excellent oral and written communication, time management and organizational skills
•Ability to work occasional overtime to meet project deadlines
•Ability to work under pressure and perform with minimal supervision
•Ability to respond to new information, changing conditions, or unexpected obstacles
•Ability to view issues/problems from different perspectives and consider alternative approaches to problem solving
•Ability to strive to take actions that are acceptable to others having different views.
•Two years of college
•Two years equivalent job experience working with the elderly population
VIVA Health - 2 years ago