Job Details

Overview:

TekWissen is a global workforce management provider headquartered in Ann Arbor, Michigan that offers strategic talent solutions to our clients world-wide. Our client is a health insurance company. It offers different types of health care coverage plans that include individual and family, dental and vision, plans for employers, etc.

Title: Grievance &Appeals Coordinator

Work Location: Detroit, MI, 48226

Duration: 6 Months

Job Type: Contract

Work Type: Remote

Dept: MA Grievances and Appeals

Engagement Description:

• Process appeals and grievances, analyse, research, and provide comprehensive responses in accordance with established regulatory and accreditation guidelines.
• Contact customers to gather information and communicate disposition of case.
• Conduct pertinent research in order to evaluate, respond to, and finalize case.
• Familiar with standard concepts, practices, and procedures for analysing, interpreting data and applying contract and regulatory provisions.
• High School Diploma or GED required.
• Bachelor's Degree in English, Communications or related field preferred.
• Two (2) years customer service experience required.
• Two (2) years health insurance experience and familiarity with health insurance state and federal regulations preferred.
• Strong project management skills preferred.

• Experience handling a large load of work in a fast-paced environment and have computer skills!
• Insurance, Medicare/CMS knowledge
• Customer Service Experience

• Writing Letters
• Analytical thinker
• Research Skills
• Multi-task

• Grievance and Appeals experience.
• Degree in Healthcare/computer skills
• Experience in analyzing a claim
• Experience in classification between a grievance/appeal/organizational determination.
• Letter writing
• Basic computer skills. How to save a PDF, how to navigate excel, learning new systems

• Healthcare, English