Role: Appeals & Grievances Specialist – Remote
Location: Oklahoma City, OK 73102
Pay Rate Range: $ 18.50 hour
Job Responsibilities:
- Assist in the investigation for all Member and Provider appeals and/or grievances
- Call members and providers to determine the root cause of their issue
- Review claims and referrals to determine the validity of the appeal and ensure all internal process were followed correctly
- Document all research findings
- Provide a summary of findings to the reviewer, and provide a recommendation for resolution
- Follow all guidelines provided by CMS as well as the GlobalHealth compliance team
- Inform the member of the resolution of the issue via call or letter
- Inform management of training opportunities for coworkers to help prevent future appeals and grievances
- Make outbound calls to members when their doctor is no longer in the GlobalHealth network
- Update the member information in the GlobalHealth system to reflect their new doctor
- Send member notification letters to confirm changes to their providers
Requirements:
- 1+ year experience in Appeals and Grievances
Addison Group is an Equal Opportunity Employer. Addison Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state, and local laws. Addison Group complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities. Reasonable accommodation is available for qualified individuals with disabilities, upon request.