Appeals & Grievance Liaison Associate

The Impact You Will Have

This role will provide an important expansion of our job family structure within Appeals & Grievances.The position will offer visibility into the entire appeals process, but it will focus on the most critical aspect of the job - getting the work transferred/assigned to the right area or person quickly. This is imperative so we can position ourselves to successfully meet our internal Service Level Agreements (SLAs), external SLA requirements, regulatory requirements, and contractual obligations. This position is responsible for preliminary, high-level research and triaging of cases based on business rules. Individuals in this position work collaboratively with team members and internal business partners on problem resolution and process improvement opportunities.

Your Responsibilities

• Assign cases through the appeals management tool (moving work).
• Research and respond to provider & member inquiries including provider close-out letters and Livanta notifications. Assign executive inquiries, support remote cases for member & provider, review and research duplicate cases and other duties as assigned to ensure we meet departmental goals.
• Support external audit preparation.
• Work with third party vendors to obtain documents and translation requests
• Respond to incoming faxes deemed urgent. Set up and assign to Liaisons.
• Provide reporting support with daily workbasket counts.
• Perform advanced validation support for appeals & other complex documents using the IBM Datacap workflow system.

Required Skills & Experience

• 1 year of relevant work experience.
• All relevant experience including work, education, transferable skills, and military experience will be considered.
• Knowledge of state and/or federal regulatory policies and/or provider agreements, and a variety of health plan products.
• Demonstrated ability to write clear, concise and grammatically correct materials with ability to express complex concepts in simple terms.
• Excellent verbal communication skills with the ability to express complex concepts in lay terms.
• Demonstrated ability to research, analyze, problem solve and resolve complex issues.
• Demonstrated strong organizational skills with ability to manage priorities and change.
• Demonstrated ability to work independently and in a team environment.
• Proficient in multiple PC based software applications and systems.
• Adaptable and flexible with the ability to meet deadlines.
• High school diploma (or equivalency) and legal authorization to work in the U.S.

Preferred Skills and Experience

• Claims and/or Customer Service knowledge.
• Understanding of the appeal validation process.

Compensation and Benefits:

Pay Range: $21.64 - $27.05 - $32.46 Hourly

Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.

We offer a comprehensive benefits package which may include:

• Medical, dental, and vision insurance
• Life insurance
• 401k
• Paid Time Off (PTO)
• Volunteer Paid Time Off (VPTO)
• And more

To discover more about what we have to offer, please review our benefits page.