Med Appeals and Grievance Specialist II (Remote - AZ)

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Requirements:

• Associate’s Degree in a healthcare field or Nursing Diploma.
• Active, current, and unrestricted license to practice in Arizona as RN, PT, or LMSW.
• Experience level varies from 1 to 8 years in clinical health insurance or healthcare-related field, with additional specificity related to managed care expertise for higher levels.

Responsibilities:

• Perform in-depth analysis and clinical review of provider appeals and grievances.
• Identify, research, process, and respond to customer inquiries through various communication methods.
• Maintain accurate records per department policy and meet quality standards.
• Consult and coordinate with internal and external stakeholders to ensure resolution of inquiries.
• Participate in meetings and maintain knowledge of industry developments.