Grievance & Appeals Coordinator I - 210056

BC Forward is Looking for Grievance & Appeals Coordinator I Work Location: Remote (Arkansas preferred)

Job Description: Grievance & Appeals Coordinator I
Work Location: Remote (Arkansas preferred)
Duration :3+ Months
Schedule: Monday - Friday, 8:00 AM - 5:00 PM CST
Pay Rate: $21/hour

Position Purpose

The Grievance & Appeals Coordinator I is responsible for analyzing, researching, and resolving verbal and written claims and authorization appeals submitted by providers, as well as addressing formal grievances from members. This role requires strong organizational, communication, and problem-solving skills to ensure timely and accurate case resolution.

Key Responsibilities

• Review provider and member appeals regarding denied medical claims.
• Forward appeals to vendors for review and follow up with decisions (uphold/overturn).
• Prepare and send written notifications of appeal decisions to members and providers; make phone calls when required.
• Gather, analyze, and report on verbal and written complaints, grievances, and appeals.
• Draft and issue response letters for member and provider grievances/appeals.
• Maintain organized files on all appeals and grievances.
• Coordinate Grievance & Appeals Committee activities as needed.
• Support pay-for-performance programs, including data entry, tracking, and information research.
• Assist with HEDIS functions such as data entry, provider outreach, and claims research.
• Manage high volumes of documents, including copying, faxing, scanning, and mail processing.

Required Skills & Experience

• High School Diploma or equivalent (Associate's degree preferred).
• 2+ years of experience in grievances, appeals, claims processing, or managed care.
• Strong oral and written communication skills.
• Strong problem-solving and organizational skills.
• Proficiency in Microsoft Word and general computer skills.
• Experience with healthcare claims or provider appeals.

Preferred Skills

• Associate's degree in healthcare administration or related field.
• Experience with medical claims processing and managed care systems.

Performance Expectations

• Complete at least 2 appeals per day in line with department standards.
• Maintain accuracy and compliance with company and regulatory requirements.
• Contribute positively to a collaborative, team-oriented culture.

Interested candidates please send resume in Word format Please reference job code 243613 when responding to this ad.