Appeals & Grievances Rep I

SummaCare - 1200 E Market St, Akron, OH

Full-Time / 40 Hours / Days

Hybrid

Summary:
Reviews, processes, submits, and tracks post service and non-expedited appeals/grievances. Communicates to departments responsible for implementing determinations.

Formal Education Required:
a.High School Diploma or equivalent

Experience & Training Required:
a. One (1) year experience. Relevant experience includes:
i. Appeals /grievance experience in a managed care environment, OR
ii. Claims processing, member services or patient care experience in a healthcare environment, OR
iii. Administrative support in any industry.

Other Skills, Competencies and Qualifications:
a. Demonstrate ability to learn and maintain current understanding of various benefit packages, including basic knowledge of claims processes and systems.
b. Communicate effectiv...