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+ Pursues ongoing education/training on benefits/services to ensure accurate resolution of grievances and appeals, and overall industry knowledge and development (i.e. Identifies barriers to customer satisfaction and recommends actions to address operational challenges. + Generates written correspondence to members, providers and regulatory agencies. + Contacts members to gather information and communicate disposition of case documents interactions. + Ensures appropriate resolution to inquiries, grievances and appeals within specified timeframes established by either regulatory/accreditation agencies or customer needs. + Responds to oral and written complaints sent to the Office of the Chairman, President or Vice President complaints. Primary duties may include, but are not limited to: + Summarizes and presents essential information for the clinical specialist or medical/dental director and legal counsel. + Triages clinical and non-clinical inquiries, grievances and appeals, prepares case files for member grievance committees/hearings. How you will make an impact: + You will be responsible for investigating and reviewing customer grievances and appeals regarding provision of service and benefit coverage issues. Beacon Health Options is a proud member of the Elevance Health family of companies. Beacon offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care. Do you want to be part of a larger purpose and an evolving, high performance culture that empowers you to make an impact? Build the Possibilities. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change.

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Grievance & Appeals Coordinator + Location: National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint + Job Family: CLM > Claims Support + Type: Full time + Date Posted:+ Req #: PS75058 Description Grievance and Appeal Coordinator Remote Be part of an extraordinary team We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. Elevance Health will also follow all relevant federal, state and local laws. If you are not vaccinated, your offer will be rescinded unless you provide - and Elevance Health approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. We require all new candidates to become vaccinated against COVID-19. Covid-19 Vaccination Guidance: UPDATED 12/9/21: The health of our associates and communities is a top priority for Elevance Health.