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Department(s) : Grievance & Appeals Resolution Services (GARS)
Reports to : Manager, Grievance & Appeals
Salary : $24.52 - $31.04
Duration : up to 6 months
Job Summary
The Grievance Resolution Specialist coordinates the Grievance and Appeal resolution process, responds to verbal and written Grievances and Appeals from members and / or providers relating to member eligibility and benefits, contract administration, claims processing, utilization management decisions, and pharmacy and vision decisions.
The incumbent has frequent external contact with members and families, healthcare providers, health networks, third-party administrators, and regulators.
The incumbent collaborates with internal departments such as Customer Service, Provider Operations, Pharmacy, and Medical Management to identify factors necessary for the optimal resolution of Grievances and Appeals.
Position Responsibilities
Possesses the Ability To :
Experience & Education
Preferred Qualifications
Knowledge of :
The Midtown Group is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Full Time
Business Services
$91k-108k (estimate)
05/14/2024
06/21/2024
themidtowngroup.com
BETHESDA, MD
25 - 50
1989
Private
HELEN STEFAN-MOREAU
$10M - $50M
Business Services
The Midtown Group provides staffing services to government and IT sectors.