Summary of Position
We are seeking a talented Grievance & Appeals Specialist who will be responsible for responding to written/verbal grievances, complaints, appeals, and disputes submitted by members and providers in accordance with NCQA, CMS, State, and other regulations. They will process appeals and grievances to facilitate the accurate administration of benefits and clinical policy; and ensure compliance of the appeal and grievance process with all regulatory requirements and NCQA standards. This individual will work as an effective interface between internal and external customers and maintain good member and provider relations
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