The Appeals and Grievance Coordinator is responsible for investigating and providing resolution to, member and authorized member representative, verbal and written complaints, grievances, and requests for appeals that involve complex matters based on comprehensive research to clarify facts and circumstances in compliance with statutory and regulatory requirements. The Appeals and Grievance Coordinator will ensure that issues are properly classified and categorized to ensure complete and accuracy of report submissions to internal stakeholders, oversight committees, and regulatory agencies.
The Appeals and Grievance Coordinator prepare and documents summaries and write resolution letters for members, which include summarizing member complaints and steps taken to resolve complaint(s) and maintain grievance and appeals case files in the Health Plan's database(s). The Appeals and Grievance Coordinator attends and presents cases at bi-weekly and ad hoc Grievance and Appeals Committee.
The ideal candidate has strong written and verbal communications skills, is a critical thinker and listener, has the ability to effectively interact with customers, and is proficient in working with databases.
Immediate eligibility for health and welfare benefits
401(k) savings plan with dollar-for-dollar match up to 5%
PTO accrual beginning Day 1
*Note: Benefits may vary based upon position type and/or level.
- EDUCATION - H.S. Diploma/GED Equivalent
- EXPERIENCE - A minimum of 2 years experience required
Internal Number: 20013353
About Baylor Scott & White Health
Baylor Scott & White Health (BSWH) is the largest not-for-profit health care system in Texas and one of the largest in the United States. With a commitment to and a track record of innovation, collaboration, integrity and compassion for the patient, BSWH stands to be one of the nation’s exemplary health care organizations. Our mission is to serve all people by providing personalized health and wellness through exemplary care, education and research as a Christian ministry of healing. Joining our team is not just accepting a job, it’s accepting a calling!