Grievances & Appeals Specialist I

Ensure cases are accurately classified and categorized while analyzing, researching, and managing inventories. Respond to member and provider requests within regulatory requirements and plan policy. Prepare comprehensive case histories for committee meetings and audits, and determine if additional documentation is needed. Interpret business rules, policies, and contract language to prepare appeal cases for independent specialty reviewers. Present case information to multi-department committees. Requires 3 years of health industry experience, strong communication skills, and familiarity with ICD-10, CPT coding, and Individual/Group Contract language. Pay range is $23.63 to $33.09.