Grievance & Appeals Coordinator Position Available In Jackson, Missouri

Salary Not Available
Position range in Kansas City, MO-KS Metropolitan Statistical Area $101k•$166k Per Year Grievance & Appeals Coordinator
WPS Health Solutions

Occupation:

Managers, All Other

Location:

Kansas City, MO•64153
Positions available: 1
Job #:

GRIEV005884MO

Source:

FileImport•WPS Health Solutions

Posted:

6/13/2025

Expires:

12/10/2025

Web Site:

recruiting2.ultipro.com

Job Type:

Regular, Full Time (30 Hours or More) Job Requirements and Properties Help for Job Requirements and Properties. Opens a new window. Job Requirements and Properties Help for Job Requirements and Properties. Opens a new window.
Work Onsite
Full Time Schedule
Full Time Job Type
Regular
Job Description Help for Job Description. Opens a new window. Job Description Help for Job Description. Opens a new window.
Description
As a Grievance and Appeals Coordinator, you will investigate and resolve complex patient and insurance provider complaints related to claims, enrollment, medical authorization denials, within the healthcare industry. You will act as a liaison between the member, insurance provider, and medical service providers to ensure timely and fair resolution of all appeals and grievances. Reporting processes will be created and maintained in this role to support the overall savings for the company while maintaining the membership and provider support of our company. Hourly Rate of Pay $22.00/hour•$27.00/hour Work Location We are open to remote work in the following approved states:

Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, North Carolina, North Dakota, Ohio, South Carolina, South Dakota, Texas, Virginia, Wisconsin How do I know this opportunity is right for me?

If you:

Have efficient researching and investigative skills. Can communicate with confidence, clarity and sound reasoning when resolving an issue. Are a self-starter, work independently, and can reprioritize as new situations arise. Have experience with regulatory information and are familiar with healthcare data such as PHI and PII. Have strong skills and technical acumen that could include the following skillsets: computer navigation and working within multiple applications, telephone support, letter writing and composition, project management. Have strong organizational skills and documentation. Are able to learn new products and processes. Want to be an innovator helping to bring process improvements and develop reporting and tracking strategies. Approach situations with empathy and adaptability in mind. What will I gain from this role? Deep understanding of the WPS certificates and Medical Policies. Hands on experience in resolving grievances and appeals for our members. The opportunity to participate in professional development and training. Independence to solve problems investigate issues and utilize sound decision making skills constantly. Knowledge and participation of audits with Utilization Review Accreditation Commission (URAC). Working on a diverse team environment of clinical staff including Nurses, Medical Directors, Quality and Intake Specialists. Opportunities to learn, train and create process improvements and best practices to the division. Experience working in an environment that serves our nation’s military, veterans, Guard and Reserves, and Medicare beneficiaries. Working in a continuous performance feedback environment. Minimum Qualifications High School Diploma or equivalent. 2 or more years of experience in claims processing, customer service, or a related role in the health insurance industry. Familiarity with federal and state regulations governing health insurance claims and member rights. Excellent communication skills, both written and verbal, with the ability to explain complex information to members in an understandable way. Strong problem-solving skills and attention to detail with the ability to manage multiple cases and meet deadlines. Preferred Qualifications Associate’s degree or higher in healthcare administration, business, or related field. 3 years or more of professional work experience within healthcare, insurance or appeals. Experience with grievance and appeals processes, insurance regulations, and claims adjudication. Remote Work Requirements High speed cable or fiber internet Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at …For full information see follow application link.
Wisconsin Physicians Service Insurance Corporation is an Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities employer. Help for Employer Information. Opens a new window.