Grievance and Appeals Coordinator

Johnson Service Group

CA(remote)

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JOB DETAILS

SALARY

$29–$35 Per Hour

SKILLS

Call Centers, Communication Skills, Corporate Compliance, Customer Support/Service, Maintain Compliance, Managed Care, Medi-Cal, Medicare, Organizational Skills, Regulations, Regulatory Requirements, Resolve Customer Issues, Social Sciences, Writing Skills

LOCATION

POSTED

10 days ago

Johnson Service Group (JSG) is seeking a Grievance and Appeals Coordinator. This is a remote role but MUST Live in California.
Work Schedule/ Hours: Monday-Friday 8:00am-5:00pm
Pay rate: $29.00-35.00 DOE

General Description
Implement Company Grievance and Appeals processes by resolving complaints filed by Company members and their representatives as well as provide back-up support to Member Services and CareAdvantage units.

Duties & Responsibilities

Essential Functions:

Research and resolve member complaints for all lines of business ensuring compliance with Company Grievance and Appeals policies and procedures.
Maintain grievance and appeals case files in Company database.
Effectively communicate with members and providers verbally and in writing.
Prepare summaries and write resolution letters for members, which include summarizing member complaints and steps taken to resolve complaints in clear and grammatically correct language.
Attend and present cases at bi-weekly Staff Grievance and Appeals Committee.
Prepare files for appeals to regulatory agencies.
Maintain current on all regulatory requirements as they apply to grievance and appeal processes.
May, as needed, provide necessary coverage in the call centers for Member Services and CareAdvantage.

Secondary Functions:

Perform other duties as assigned.

Qualifications
The following represents the typical way to achieve the necessary skills, knowledge and ability to qualify for this position:

Education and experienceequivalent to:

Associates degree in health, business, social sciences, or humanities, preferred.
Two (2) years of experience working with Medi-Cal or Medicare in a managed care environment preferred. Work performing grievance and appeals processing preferred.
Work in a call center, claims department, and/or other customer service position required.

JSG offers medical, dental, vision, life insurance options, short-term disability, 401(k), weekly pay, and more. Johnson Service Group (JSG) is an Equal Opportunity Employer. JSG provides equal employment opportunities to all applicants and employees without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, marital status, protected veteran status, or any other characteristic protected by law. #D800

About the Company

Johnson Service Group

At JSG, We Understand People

It is our mission to empower people, help our clients reach their goals, and hire motivated individuals.

Since our start in 1984, we’ve worked hard to establish our present position as the most effective cross-industry staffing and consulting solution available.

Headquartered in Chicago, IL with local offices throughout the United States and Canada, JSG proudly serves a diverse range of industries with the right solutions to help clients reach their company goals. Our client-centric approach enables us to create personalized solutions for businesses in need of top-tier talent. Our dedication doesn’t stop at our clients. We strive to connect candidates with opportunities that match their skills and goals. More than just a go-between, we are a dependable bridge, uniting top talent with suitable opportunities, facilitating shared opportunities and growth.

COMPANY SIZE

1,000 to 1,499 employees

INDUSTRY

Staffing/Employment Agencies

FOUNDED

1984

WEBSITE

https://www.jsginc.com/

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