About the job
Job Summary: The Grievance & Appeals Specialist III, in collaboration with department leadership, is responsible for processing and responding to claim appeals and disputes, and provides the department with subject matter expertise in clinical and code edit denials. Essential Functions: Review a variety of appeals including, but not limited to: high difficulty appeals, consent appeals, state complaints, dental appeals, low difficulty appeals, member and provider appeals, non-clinical appeals (i.e. tobacco surcharg…
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