Find Your Next Opportunity
Direct Hire, Contract, Contract to Hire
- Start your job search below
- Filter by Location, Remote Jobs, Keywords, and more. Save your keyword searches for automated notifications when new jobs are added.
- Apply!
Grievance Analyst
Grand Rapids, MI 49525 US | Fully Remote TELECOMMUTE US
Job Description
- 100% Remote
- Remote work for this position may be approved based on policy and business considerations. Some states are not eligible for remote work (CA, CT, MA, NJ, NY, Washington D.C.)
- The length of this contract is set for 3 months.
- Equipment provided
- Effectively administer all steps of the grievance and review processes for non-Medicare products pleasantly and expediently to ensure quality customer service and compliance with all legislative, regulatory, and accreditation requirements. Assist customers throughout the process by providing complete information and follow-up on a timely basis. Ensure committee, State, and Federal decisions are properly implemented.
- Responsible for the analysis, research, and completion of complex member appeal investigations. Effectively administer all steps of the member appeal and fair hearing review processes for all non-Medicare products to thoroughly investigate appeal requests, leveraging critical thinking skills, gathering relevant information from enterprise-wide systems, and collaborating to resolve issues whenever possible. Ensure compliance with all mandated, legislative, regulatory, and accreditation requirements.
- Assist customers and staff throughout the process by providing complete information and follow-up on a timely basis. Ensure committee, State, and Federal decisions are properly implemented. Assist the Lead, Supervisor, and/or Manager in coordinating activities and in the development/collection of materials required to meet and demonstrate compliance with all state, federal, and accrediting organization requirements. Prepares and presents education to internal departments. Serves as a mentor/trainer to other team members.
- Apply strong analytical skills and business knowledge to investigate, analyze, and recommendation of solutions Communicate, collaborate, and act as a consultant to internal and external customers to resolve complex issues.
Job Requirements
- Required Associate's Degree or equivalent
- Preferred Bachelor's Degree or equivalent
- 5 years of relevant experience in Grievance & or Appeal Analyst or related experience Required
- 3 years of relevant experience in Member or Provider Customer service, Claims, Legal, and/or enrollment/eligibility Preferred
- Working knowledge of Health systems for claims payment, care management, authorizations, customer service interactions, pharmacy, Rx profiles, medical policies, and plan documents for all non-Medicare product lines (Commercial Group, Commercial individual, Insurance Company, Self-funded, Government Programs - Medicaid) Preferred
- Extensive knowledge of managed care products and regulatory and accreditation requirements; Maintain knowledge of policies and procedures, including medical policies which may impact the grievance, appeal, and review processes Preferred
Contract positions
Will be employed and paid hourly by iMPact Business Group. Benefits (medical, dental & vision) are available after 90 days of employment.
Permanent placed employees
Paid by and qualify for benefits in accordance with the policies of the hiring company.
Submit your resume today to be considered for this position. A recruiter will review within a business day or two and will reach back out to you if they would like to discuss next steps.
Internal Positions
We have several internal positions at iMPact that we are hiring for. Please view our internal positions here.
- Recruiters
- Account Managers
Learn more about working with iMPact Business Group
Share This Job:
Related Jobs:
About Grand Rapids, MI
Are you sure you want to apply for this job?
Please take a moment to verify your personal information and resume are up-to-date before you apply.