Medical Claims Representative
Houston , Texas
November 25, 2017

The Position is a multifaceted position centered on activities related to screening of appeals concerning customer complaints, medical necessity and claims appeals, and the coordination of Grievance and Appeals. The primary responsibility is to manage and coordinate the provider and enrollee grievance/appeals process as well as initiation of Independent Review Organization (IRO) external reviews process as relates to Adverse Determinations based on non-medical necessity. The position will carry out various quality improvement activities, commitment to Partner-In-Caring Process and Behavioral Expectations in all interactions and in performing all job duties. The position will promote quality patient care and customer service/satisfaction, while promoting safety, cost efficiency and a commitment to the Continuous Quality Improvement Process. The Appeals Grievance Coordinator will interact on a daily basis with the Customer Service Department, Medical Management Department, Medical Directors, enrollees, providers and TPA Staff as may be necessary to effectively resolve appeals, complaints and quality of care or service issues

A little about us:
Founded in 1948, Robert Half (NYSE: RHI) is the world's first and largest specialized staffing services firm.

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