Grievance & Appeals Coordinator I - 210056

Grievance & Appeals Coordinator I - 210056

BCforward is currently seeking a highly motivated Grievance & Appeals Coordinator I for an opportunity in 100% Remote, SC

Position Title: Grievance & Appeals Coordinator I

Location: 100% Remote, SC

Duration: 6.5 months Possibility of Extension OR Conversion to FTE

Shift: Required shift 8am-5pm (EST) Monday through Friday

Pay Rate: $23/hour

Job Description:

Position Purpose:

• Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.

Education/Experience:

• High school diploma or equivalent. Associate's degree preferred. 2+ years grievance or appeals, claims or related managed care experience. Strong oral, written, and problem solving skills.

• Gather, analyze and report verbal and written member and provider complaints, grievances and appeals

• Prepare response letters for member and provider complaints, grievances and appeals

• Maintain files on individual appeals and grievances

• May coordinate the Grievance and Appeals Committee

• Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information

• Assist with HEDIS production functions including data entry, calls to provider's offices, and claims research.

• Manage large volumes of documents including copying, faxing and scanning incoming mail.

Typical day look like:

• The daily schedule is 8:00 - 5:00 with a 1-hour lunch to be taken between 11:00 and 1:00 M-F

• This is a production role; work will be provided through a queue using the CenPas system with high focus on aging and timeliness.

• This is a close nit team with active engagement via Microsoft Teams

• Outbound Calls, Data Entry, Research

Benefits:

BCforward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.

About BCforward:

Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally.

BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.

BCforward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.

To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.

This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.

Interested candidates please send resume in Word format Please reference job code 249892 when responding to this ad.

---