Blue Shield of CA
Appeals and Grievances Representative, Advanced- CalPERS
Blue Shield of CA, San Diego, California, United States, 92189
Your Role
The Appeals and Grievances team receives, documents, investigates, refers, and coordinates grievances, appeals and complaints for our Commercial line of business. The Appeals and Grievances, Advanced Coordinator will report to the Appeals and Grievances Supervisor. In this role you will be responsible for taking incoming telephone calls, reviewing, researching, and responding to incoming appeals and grievances within established compliance timeframes.
Your Knowledge and Experience
Requires a high school diploma or GED
Requires at least 4 years combined operations experience such as I&B, Claims, Customer Services, Regulatory Affairs; of which at least 1 year of direct experience is in Appeals/Grievances, or similar combination
Requires knowledge of Microsoft Systems such as Power Point, Excel, and Word
Commercial appeals and grievances knowledge or experience preferred
Note: You may be placed in a specialty client, or other unit, such as CalPERs.