What are the responsibilities and job description for the Grievance & Appeals Coordinator position at Professional Management Enterprises?
Description
Position Overview:
We are seeking an organized, detail-oriented Grievance & Appeals Coordinator to process appeals within contractual timelines, review and resolve member and provider complaints, and ensure compliance with all regulatory and contractual requirements.
The ideal candidate will have outstanding written and verbal communication skills and the ability to self-manage their time effectively in a fast-paced environment. Experience in the transportation industry is a plus.
Why Join Us?
- Bright, modern, and welcoming, office space filled with natural light and positive culture.
- Competitive pay range of $19–$21/hour, based on experience.
- Opportunity to make a meaningful impact on member and provider satisfaction.
Key Responsibilities:
- Accurately enter and track appeals in the system within required timeframes.
- Analyze and resolve verbal and written claims and authorization appeals from providers.
- Investigate and resolve formal grievances from members.
- Prepare clear, professional response letters for members and providers.
- Maintain well-organized, complete files for each case.
- Support pay-for-performance programs through data entry, tracking, research, and organization.
- Assist with research activities, including data entry, provider calls, and claims research.
- Manage large volumes of documentation, including scanning, faxing, copying, and processing incoming mail.
Requirements
- High school diploma or equivalent required; Associate’s degree preferred.
- 0–2 years of related experience; transportation industry experience is a plus.
- Outstanding written and verbal communication skills.
- Strong self-management and time management abilities.
- Excellent attention to detail and organizational skills.
- Proficiency with Microsoft Office and ability to learn new systems quickly.
Salary : $19 - $21