Remote Jobs at Alignment Health

The Appeals & Grievance Coordinator is responsible for the day-to-day functions of the tracking and trending of all grievances, appeals, and complaints received within the Member Services Department. Acts as the primary investigator and contact person for member and provider grievances and appeals. GENERAL DUTIES/RESPONSIBILITIES : 1. Acknowledges the receipt of all grievance/appeals, and CTM (Complaint Tracking Module). 2. Gathers pertinent and relevant information from the member and/or provider regarding the grievance/appeal, determines the appropriate resolution of the grievance/appeal per standard policies and procedures; and notifies the appropriate parties of the resolution and ensuring that all internal processes are completed to resolve the issue. 3. Composes written correspondence to members in accordance to plan policy and CMS Guidelines. 4. Conducts non-biased, accurate, timely and comprehensive investigation of all the facts related to the grievance/appeal. 5. Thoroughly ...