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Appeals & Grievances Clerk in Coral Gables, FL at Beacon Health Options

Date Posted: 2/12/2019

Job Snapshot

Job Description

About the Position:

Beacon Health Options is currently seeking a dynamic Appeals Clerk to join our team in Coral Gables, FL! General Under the direction of the Appeals and Complaints Management Team, the Appeals Clerk will contribute to overall customer satisfaction by providing clerical and administrative supports to a group of Grievances and Appeals Coordinators.

 This position is responsible for document processing controls, daily work distribution activities, document control, and data entry.  The incumbent conducts on the job training/support, monitors inventory, timeliness, work flows, reporting and assists management with special projects and administrative tasks. The Appeals Clerk also resolves issues by interacting with all levels of management staff and acts as a role model, leading by example, to promote morale within the department.

Position Responsibilities:

  • Generate and triage appeal and complaints cases to Grievances and Appeals Coordinators. Support and manage all appeal inventory queues for timeliness, appeal documentation, and case management according to client performance guarantees and departmental service level agreements.
  • Monitor fax server, build case inquiries and route inquiries to the appropriate queues to Appeals Coordinators, daily.  This includes examining queues to determine work assignments and monitoring account performance expectations to meet service level agreements. 
  • Manage daily inventory reports; identify appeal and complaint cases at risk. Facilitate meetings with Appeals Management Team to recommend solutions to mitigate risks and case recovery.
  • Ensure incoming and outgoing appeal and complaint resolution correspondences are posted to mail according to regulatory and contractual guidelines.
  • Assist Management with appeal and complaint escalations and inter-departmental liaison for local and corporate engagement.
  • Demonstrate a thorough knowledge of all lines of business/company procedures related to appeal operations, support inquiry resolution for all customer and products, report issues and offer suggestions for improvement to management.
  • Advise Appeals leadership of any policies and procedures needed to support the unit and work closely with the Quality Analyst to identify any process, procedure or system issues that impedes the units opportunity to meet quality performance measures 
  • Compliance with Beacon Health Options and client contractual requirements for proprietary and intellectual property.
  • Provide clerical support, including, but not limited to, filing, distribution of work, copy and other clerical functions to support business needs

Position Requirements:

  • Education: Associate’s degree or equivalent related experience is required
  • Relevant Work Experience: 6 months or more clerical, administrative experience in healthcare or a related field required
  • Knowledge, Skills, & Abilities:
    • Knowledge of resources available within the organization to resolve internal/external problems and concerns is preferred, i.e. Customer Services, Appeals, or Claim Operations.
    • Excellent written, verbal, and interpersonal skills required
    • Excellent analytical, problem solving, and decision making skills required
    • Strong ability to prioritize tasks with excellent time management and organization skills required

To Apply:

Click below on “Apply for this Position” to create a profile and apply for the position

Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment.  EOE/AA/M/F/Veterans/Disabled

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