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salary:

$19.76 - $19.77 per hourshift: Firstwork hours: 8 AM - 5

PMeducation:

High SchoolResponsibilitiesPosition Summary:

Investigate and resolve verbal and written member and provider complaints, claims, and authorization appeals in compliance with state Medicaid regulations and turnaround standards.

Key Responsibilities:

Analyze member and provider grievances, complaints, and appeals to determine appropriate resolutions. Conduct outbound calls to members to explain the grievance process and collect relevant case details. Draft formal, professional response letters detailing appeal outcomes within mandated timelines. Organize caseload by due date, complete system case documentation, and maintain organized records. Support pay-for-performance programs, HEDIS functions, and routine document management.

Requirements:

High School Diploma or GED required (Associate's degree preferred). 2+ years of experience in healthcare grievances, appeals, claims, or managed care. Deep knowledge of Iowa Medicaid programs, services, and policies. strong written, verbal, and problem-solving skills with high attention to detail.

Preferred:

Previous call center or high-volume phone experience.

SkillsMicrosoft OfficeAdobeMulti-taskingPrioritizingQualificationsYears of experience:

2 yearsExperience level: ExperiencedRandstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad.

Equal Opportunity Employer:

Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).This posting is open for thirty (30) days. It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. 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Find & Apply For Enrollment / Eligibility Specialist Jobs in West Des Moines, Iowa

GRIEVANCE APPEALS COORDINATOR I