Description We are seeking an experienced Medical Grievances and Appeals Specialist to join our dynamic team. The successful candidate will be responsible for managing all grievances, appeals and complaint processes related to medical services. You will also play an instrumental role in ensuring consistent adherence to company and legal standards. Responsibilities: + Process all medical grievances, appeals, and complaints in a timely, accurate and efficient manner. + Review and analyze documentation provided by members, physicians and other stakeholders for validity. + Conduct thorough research and investigation into each case to provide accurate and fair resolution. + Collaborate with appropriate departments to identify trends and areas for improvement. + Advocate for members and work to resolve their issues in compliance with company policies and regulations. + Provide educational assistance to members regarding the grievance and appeals process. + Ensure record keeping system is maintained and includes all necessary information. + Prepare reports on grievances and appeals for upper management. Requirements • Proficient in Appeals Submittal processes and procedures • Experience in handling Medical Grievances • Demonstrable knowledge in Medical Claims • Proven ability in managing Insurance Claims • Excellent analytical and problem-solving skills • Strong communication and interpersonal skills • Ability to work under pressure and meet deadlines • Detail-oriented with high level of accuracy • Knowledge of healthcare industry standards and regulations • Proficient in Microsoft Office Suite and data management software • Ability to maintain confidentiality and adhere to ethical standards • Willingness to continually update knowledge and skills in healthcare industry. Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles. Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more. Robert Half will consider for employment qualified applicants with arrest or conviction records in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information. © 2024 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking “Apply Now,” you’re agreeing to Robert Half’s Terms of Use (https://www.roberthalf.com/us/en/terms) .