Case Specialist, Grievance and Appeals

Job overview

The Case Specialist, Grievance and Appeals role is hybrid, with the employee required to reside within commuting distance of Rhode Island and attend the office as needed. Pay is $25 per hour. The role supports grievance and appeals work for company products in a managed-care environment.

What you'll do

• Investigate and resolve member and provider complaints, benefits appeals, and administrative appeals
• maintain case documentation and follow up
• respond to telephone and written inquiries
• educate members about their healthcare plans
• identify and escalate potential quality-of-care issues
• collaborate on trend and root-cause analysis and process improvements
• prepare for departmental audits and regulatory site visits.

What we're looking for

Skills & competencies

case specialist

grievance and appeals

hybrid

rhode island

$25/hr

managed care

medicare

member appeals

provider complaints

case documentation

regulatory audits

4+ years experience

Work arrangement

• Weekend coverage required

Benefits & perks

• Medical, dental, and vision insurance
• 401(k) retirement savings plan.

Why this role

Requires 4+ years working with appeals and grievances in managed care and Medicare experience with appeals and grievances, customer service, or claims.

About the employer

The Jacobson Group is hiring for this role. Industry: Direct Health and Medical Insurance Carriers. Sector: 52.