Grievance & Appeals Coordinator I

Analyze and resolve verbal and written claims and authorization appeals from providers, and pursue resolutions of formal member grievances. Gather, review, and report complaints, prepare response letters, maintain appeal/grievance files, and may coordinate a Grievance and Appeals Committee. Support pay-for-performance programs through data entry and tracking, and assist with HEDIS production tasks including provider outreach and claims research. Manage high volumes of documents (copying, faxing, scanning) while following all policies and standards.