Grievance & Appeals Coordinator I

Grievance & Appeals Coordinator I

BCForward is looking for Grievance & Appeals Coordinator I - Remote

Position Title: Grievance & Appeals Coordinator I
Location: Remote to AR/ Central Time Zone
Anticipated Start Date: ASAP
Expected Duration: 03+ months of contract
Shift: Monday - Friday, 8:00 AM - 5:00 PM CST
Potential to Extend: Yes

Pay Rate: $$21 per hour

Job Type: [FULL TIME (>%3D40 HRS WEEKLY, [CONTRACT], [REMOTE]

Job Summary:

The Grievance & Appeals Coordinator I will be responsible for reviewing and processing medical claim appeals submitted by providers and members. This role ensures compliance with established policies and regulatory requirements while working within a collaborative and supportive team environment.

Key Responsibilities:

• Review faxes received from providers and members appealing denied medical claims.
• Identify true appeals and forward necessary documentation to the appropriate vendor for review.
• Follow established procedures based on the vendor's decision to uphold or overturn claims.
• Notify providers and members of appeal outcomes through written correspondence, and occasionally via phone.
• Ensure all appeals are processed accurately and within required timeframes.
• Maintain detailed records of appeals and outcomes in accordance with company policies.
• Collaborate with team members to enhance workflow efficiency and maintain high-quality standards.

Performance Expectations & Metrics:

• Complete a minimum of two (2) appeals per day.
• Maintain accuracy and compliance with company guidelines and regulatory standards.
• Demonstrate strong communication and problem-solving skills in all interactions.

First Day Expectations:

• New hires will begin by shadowing experienced team members for training.
• Hands-on learning to familiarize themselves with the role and responsibilities.
• Overview of company policies, systems, and workflows.

Qualifications & Experience:

Required:

• High School Diploma or equivalent.
• Proficiency in Microsoft Word and general computer skills.
• Strong written, verbal, and problem-solving abilities.
• Experience with health claims processing and provider appeals.

Preferred:

• Associate's degree or 2+ years of experience in medical claims processing.

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.

Keywords:

Associate's degree or 2+ years of experience in medical claims processing.]

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 235214 when responding to this ad.

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