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18 days old

Appeals and Grievance Specialist

Kelly Services
Rancho Cordova, CA 95670
**Job Description**


Kelly Services is recruiting for an Appeals and Grievance Specialist for a premiere insurance provider and Fortune 500 company in Rancho Cordova, CA. You will be working in a luxury and professional environment with an abundance of perks.


Pay Rate: $25 hourly


Hours: 8AM-5PM and 9am-6pm


Location: Suncenter Dr., Rancho Cordova Ca 95670


Start Date: ASAP


Length of Assignment: Contingent to hire


Responsibilities Include:

Receives, researches, interprets and resolves beneficiary and provider complains and appeals, often high priority cases

Demonstrates regular, reliable, and predictable attendance

Ensures compliance with Medical Insurance plans regulations

Research and interprets Medical Insurance Plans regulations to solve appeals and grievances

Documents the results of complaints and appeals

Writes custom response letters to providers, beneficiaries, and representatives

Prepares case files for Medical Directors and Appeals RN for clinical determinations

Prepares case file review for the Defense Health Agency (DHA) and Quality Monitoring contractor

Prioritizes and handles escalated and high priority cases

Contacts providers via phone and in writing to help research and resolve problems

Works with subcontractors to get answers, re-do claims, follow up on problem resolution, etc.

Recommends operational and process improvements based on efficiencies and available technologies

Other duties as assigned


Job Requirements:

Some experience in managed care preferably with appeals and/or grievance resolution

Strong oral, written, and problem solving skills

Medical claims processing and business writing experience preferred


High School Diploma or GED


As a Kelly employee, you'll have access to world-class perks!


Don't Hesitate Apply Now!

Send your resume to erit256@kellyservices.com


**Why Kelly** **** **?**


At Kelly
Services , we work with the best. Our clients include 95 of the Fortune
100 companies, and more than 70,000 hiring managers rely on Kelly annually to access
the best talent to drive their business forward. If you only make one career connection today, connect
with Kelly.




**AboutKelly Services** ****




As a workforce advocate for over 70 years, we are proud to directly employ nearly 500,000 people
around the world and have a role in connecting thousands more with work through our global network of
talent suppliers and partners. Revenue in 2017 was $5.4 billion. Visit kellyservices.com and connect with us on Facebook, LinkedIn and Twitter .


Kelly Services is an equal opportunity employer including, but not limited to, Minorities, Females,
Individuals with Disabilities, Protected Veterans, Sexual Orientation, Gender Identity and is
committed to employing a diverse workforce. Equal Employment Opportunity
is The Law.

Categories

Posted: 2019-01-02 Expires: 2019-02-02

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Appeals and Grievance Specialist

Kelly Services
Rancho Cordova, CA 95670

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