Grievance Resolution Specialist at The Judge Group Inc. in Orange, California

Job Description:

Location: Orange, CA

Salary: $25.00 USD Hourly - $35.00 USD Hourly

Description: Judge Healthcare is currently seeking a Grievance Resolution Specialist in Orange County, CA!




Below you can find a basic overview of the position. For additional information or for any questions, please reach out to Jacob at jmaybrier@judge.com





Schedule: Monday-Friday, 8am-5pm (on-site)



This job will have the following responsibilities:

• Maintains adequate information in clients Health's systems; ensures data collection, summarization, integration, and reporting which includes case creation and management and events/activity tracking.
  
  


• Gathers pertinent information regarding the grievances and appeals received, including, but not limited to, member or provider concerns, supporting information related to initial decision-making, new information supporting the grievance or appeal, or supplemental information required to evaluate grievances and appeals within regulatory requirements.
  
  


• Evaluates case details, proposes recommendations, or makes decisions as applicable; ensures organization decision is implemented according to the Grievance and Appeals policies and case resolution.
  
  


• Develops resolution letters and correspondence to members and providers
  
  

Qualifications & Requirements:

• High School diploma or equivalent required.
  
  


• 1 year of experience in any of the following areas: Grievances and Appeals, Claims, Regulatory Compliance, Customer Service, or related fields required.
  
  

Again, For additional information or for any questions, please reach out to Jacob at jmaybrier@judge.com



Thank You,


Jacob

Contact: jmaybrier@judge.com


This job and many more are available through The Judge Group. Find us on the web at www.judge.com Apply Now