Appeals & Grievance Admin Support (Temporary)
Location: Orange, California US
Job Number: 1287
Position Title: Appeals and Grievance Support Clerk
Appeals & Grievance Administrative Support- Seasonal
Responsible for providing daily administrative support to the Appeals & Grievance Unit of the Member Experience Department.
Essential Duties and Responsibilities
Essential duties and responsibilities include, but are not limited to:
- Tracks all incoming member correspondence in the A&G database for case assignment.
- Responsible for the daily logging, tracking, and monitoring of incoming Appeals & Grievances (CTMs, Grievances, Appeals, Fast Tracks, etc.,) through multiple channels.
- Communicates and faxes grievance/appeal response requests to appropriate parties for the gathering of all pertinent and relevant information from the member, member representative or provider regarding the member’s concerns.
- Conducts follow up calls to providers and/or medical groups for requested documentation and ensures timely receipt and compliance with timelines set forth for compliance with CMS guidelines. All point of contacts are thoroughly documented in member’s case file.
- Responsible for assembly of and maintaining and protecting all member A&G case files in an organized fashion.
- 5. Maintains confidentiality and upholds standards for privacy and data integrity and
security of the appeals and grievance case information.
- Maintain a positive and professional relationship with AHC staff, providers,
members, and regulators.
- Any other duties as assigned by the Department Manage or Director.
This job has no supervisory responsibilities.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Education and/or Experience: High school diploma or general education degree (GED); or one to three months related experience and/or training; or equivalent combination of education and experience.
- Certificates, Licenses, Registrations: None required.
- Other Qualifications:
- Basic Computer Skills, 30 WPM (Microsoft Outlook, excel, word)
- 10-Key by Touch
- Good Communication Skills
- Previous front office experience preferred
Skills and Abilities
- Language Skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports and correspondence.
- Mathematical Skills: Ability to add and subtract two digit numbers and to multiply and divide with 10’s and 100’s. Ability to perform these operations using units of American money and weight measurement, volume, and distance.
- Reasoning Skills: Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions.
- Excellent communication skills, oral and written.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.
- The employee is frequently required to walk; stand; reach with hands and arms.
- The employee is occasionally required to climb or balance and stoop, kneel, crouch, or crawl.
- The employee must occasionally lift and/or move up to 10 pounds.
- Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- The noise level in the work environment is usually moderate.
Location City: Orange
Location State: California
Community / Marketing Title: Appeals & Grievance Admin Support (Temporary)
Who is Alignment Healthcare?
- Socially responsible
- Technologically enabled
- Concierge care
- Servant leadership
We are dedicated to transforming the complex and confusing process of medical treatment in the United States so that every link in the health care continuum becomes more efficient, productive, and effective. We built a team of people who want to make a difference. Come join the team that is changing health care one person at a time.
We believe that great work comes from people who are inspired to be their best. We invite you to explore our wide variety of roles based on your unique experience.
EEO Employer Verbiage:
Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.
If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact email@example.com.