*Position:**Grievance & **Appeals Coordinator* *Location:Michigan, Detroit(Local Only)* *INTERVIEW PROCESS: PHONE & F2F* *Duration:12+ Months*
*Top Requirements:* • High analytical and critical thinking and research skills • Ability to review, understand and apply the provisions of policies and procedures. • Ability to work independently with minimum oversight. • Excellent writing skills. Candidates should be able to write in a professional, yet conversational manner to our enrollees • Previous customer service experience • Microsoft Office Suite and Window OS *Grievance & Appeals Coordinator:* Analyze and research cases, applying critical thinking, independent judgment, and business sense to make final determinations on appeals and provide comprehensive responses within regulatory timeframes. Responsible for handling & responding to customer issues involving sensitive or highly visible issues, such as organ transplants, and referrals received from the Office of Financial and Insurance Regulation (OFIR), News Media, Better Business Bureau, etc. Conduct managerial-level conferences (MLCs) with members/providers and their representatives for BCBSM underwritten products, BCS Life, and MESSA. Troubleshoot and recommend/implement solutions evolving from appeal/MLC cases. Handle sensitive cases received from Legislative Offices and be a liaison to Governmental Affairs. Monitor the President's and Grievance hot-lines and respond to those complaints. Support Regulatory Affairs by providing information/answering case questions that will assist that area in defending BCBSM's position at hearings and external reviews conducted by the Insurance Commissioner. Attend Administrative Law Judge hearings, testifying as an expert witness. Assist the Office of the General Counsel in litigation cases and by testifying in court. *In case this position interests you and you are looking for a job change, please share below details to save on you valuable time;Pay rate expectations:Notice period:Work Authorization status:Current Location:Also share your updated resume to me* -- -- *--Thanks & Regards,Vikas Kumar Singh* *Okaya InfocomPh: 631-267-4883 Ext: 302Email: vikas.si...@okayainc.com <vikas.si...@okayainc.com>* -- You received this message because you are subscribed to the Google Groups "US_IT.Groups" group. To unsubscribe from this group and stop receiving emails from it, send an email to us_itgroups+unsubscr...@googlegroups.com. To post to this group, send email to us_itgroups@googlegroups.com. Visit this group at https://groups.google.com/group/us_itgroups. For more options, visit https://groups.google.com/d/optout.
