Employer Active
Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Summary The Grievance Resolution Specialist coordinates the Grievance and Appeal resolution process responds to verbal and written Grievances and Appeals from members and/or providers relating to member eligibility and benefits contract administration claims processing utilization management decisions and pharmacy and vision decisions. The incumbent has frequent external contact with members and families healthcare providers health networks thirdparty administrators and regulators. The incumbent collaborates with internal departments such as Customer Service Provider Operations Pharmacy and Medical Management to identify factors necessary for the optimal resolution of Grievances and Appeals.
Position Responsibilities
Possesses the Ability To:
Experience & Education
Preferred Qualifications
Knowledge of:
At Sunshine Enterprise USA LLC we firmly believe that our employees are the heartbeat of our organization and we are happy to offer the following benefits:
Competitive pay & weekly paychecks
Health dental vision and life insurance
401(k) savings plan
Awards and recognition programs
Benefit eligibility is dependent on employment status.
SUNSHINE ENTERPRISE USA LLC is an Equal Opportunity Employer and does not discriminate on the basis of race or ethnicity religion sex national origin age veteran disability or genetic information or any other reason prohibited by law in employment.
Full Time