Appeals & Grievances Specialist
1 hour ago
Maintain a current knowledge of Devoted Health products, policies and procedures with the ability to relate this information in a clear, concise manner to members, providers, and internal colleagues.
Manage the intake, investigation, and resolution of complaints and appeals in a timely and highly effective manner.
Correspond with the member to both meet requirements (written acknowledgement and closure letters and telephone contact and documentation as appropriate) and foster deeper trust with our members.
Complete data entry and documentation requirements in multiple systems.
Coordinate with internal departments relative to the status of a member appeal and the research needed to prepare the case for internal or external review.
Interact with Medical Directors, Clinical Guides, Legal, Member Service Guides and other areas in facilitating identification and resolution of appeals.
Identify opportunities for service improvement based on key themes in grievances and appeals.
Responsible for meeting all regulatory and department timelines.