Claims Review Specialist (Sacramento)

Claims Review Specialist (Sacramento)

07 Feb 2019

Claims Review Specialist (Sacramento)

Vacancy expired!

Currently hiring for full-time Claims Review Specialists for a well-established healthcare company. These positions are located in the greater Sacramento area and pay is based on experience. Responsibilities include, but are not limited to the following:- Researches and resolves member/subscriber grievances, appeals and complaints, and interprets and explains health plan benefits, policies and procedures to respondents. - Researches, reviews and resolves high level/high priority member grievances, appeals and complaints, while clarifying issues and educating customers in the process. Interprets and explains health plan benefits, policies, procedures and functions to members and providers. - Produces complex written correspondence to resolve member grievances, appeals and complaints. - Administers ongoing grievance tracking, trending and reporting for assigned grievances. - Evaluates all grievances for trend purposes and reports periodic and ad hoc trends to Risk and Quality Management departments. - Coordinates next level grievance/appeal meeting with appropriate parties and forwards documentation to the review committee. - Establishes and maintains cohesive relationships with assigned IPA partners through telephone, field work and written communication.If interested, please send your resume to abarber@aerotek.com. About AerotekOur people are everything. For more than 30 years, Aerotek Inc. has distinguished itself as a leader in recruiting and staffing services by having a deep understanding of the intersection of talent and business. As a strategic partner to more than 17,000 clients and 300,000 contract employees every year, Aerotek's people-focused approach yields competitive advantage for its clients and rewarding careers for its contract employees. Headquartered in Hanover, Md., Aerotek operates a network of over 230 non-franchised offices with more than 6,000 internal employees dedicated to serving our customers. To learn more, visit Aerotek.com.

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