Grievance Resolution Specialist
The Judge Group Inc.

Location: Orange, CA
Salary: $25.00 USD Hourly - $35.00 USD Hourly
Description: Judge Healthcare is currently seeking a Grievance Resolution Specialist in Orange County, CA!

Below you can find a basic overview of the position. For additional information or for any questions, please reach out to Jacob at jmaybrier@judge.com


Schedule: Monday-Friday, 8am-5pm (on-site)

This job will have the following responsibilities:

• Maintains adequate information in clients Health's systems; ensures data collection, summarization, integration, and reporting which includes case creation and management and events/activity tracking.
  
• Gathers pertinent information regarding the grievances and appeals received, including, but not limited to, member or provider concerns, supporting information related to initial decision-making, new information supporting the grievance or appeal, or supplemental information required to evaluate grievances and appeals within regulatory requirements.
  
• Evaluates case details, proposes recommendations, or makes decisions as applicable; ensures organization decision is implemented according to the Grievance and Appeals policies and case resolution.
  
• Develops resolution letters and correspondence to members and providers
  

Qualifications & Requirements:

• High School diploma or equivalent required.
  
• 1 year of experience in any of the following areas: Grievances and Appeals, Claims, Regulatory Compliance, Customer Service, or related fields required.
  

Again, For additional information or for any questions, please reach out to Jacob at jmaybrier@judge.com

Thank You,

Jacob

Contact: jmaybrier@judge.com

This job and many more are available through The Judge Group. Find us on the web at www.judge.com

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