What are the responsibilities and job description for the Member Grievances Specialist position at Point32Health?
About the Role
The Appeals & Grievances Coordinator is responsible for supporting the Member Appeals and Grievances Department. This includes assigning cases to specialists, entering data into the system of record, reviewing appeals for potential expedites, and classifying grievances and appeals. The coordinator also tracks and ensures timely distribution of processes addressed by appeals and grievances specialists.
This role requires a strong understanding of health plan operations, products, and benefits. The coordinator will interact frequently with providers and internal/external constituents. Strong prioritization skills and the ability to seek assistance when needed are essential.
Responsibilities
- Distribute and classify cases in compliance with applicable timeframes and regulations
- Gather information on behalf of specialists from external vendors
- Coordinate medical records requests and facilitate delivery of appeals information
- Track and ensure timely distribution of processes addressed by appeals and grievances specialists
