Grievance & Appeals Specialist I

Position Purpose: Responsible for reviewing, investigating and tracking member grievances and appeals, and provider claims disputes. Responsible for coordinating as necessary with the G&A Administrator and outside counsel during state fair hearing proceedings. Responsible for validating, assigning, and completing document folders and records for member grievances and complaints Screen all incoming grievances, appeals and provider claim disputes to ensure they are in compliance with the Arizona Revised Statutes (ARS) and Arizona Department of Health Services (ADHS) / Department of Behavioral Health Services (DBHS) policies and procedures. Coordinate conferences with appropriate parties for appeal proceedings.…