Grievance and Appeals’ RN Specialist and presents arguments in defense of the appeals. Works directly with outside counsel... for each grievance or appeal decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees...
supervision of the Senior Customer Experience Program Manager, the Member Experience Specialist will manage member engagement... Experience Specialist will use their customer service skills, patience, knowledge, understanding, and compassion to answer...
and grievance requests to identify and classify member and provider appeals. Using internal systems, determine eligibility, benefits...Summary of Position Independently investigate and respond to written/verbal appeals submitted by members, employees...
on possible solutions. Lead cross-functional teams (Payment Integrity, Provider Claims Resolution, Grievance and Appeals, Provider...