Professional Management Enterprises, Inc.

Grievance and Appeals Coordinator
Other Area(s)
Indianapolis Contract May 24, 2023
Fully Remote: Must live in Indiana. 
$20-22 per hour

Summary:  Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members. Job Responsibilities: Gather, analyze and report verbal and written member and provider complaints, grievances and appeals Prepare response letters for member and provider complaints, grievances and appeals Maintain files on individual appeals and grievances May coordinate the Grievance and Appeals Committee Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information Assist with HEDIS production functions including data entry, calls to provider’s offices, and claims research. Manage large volumes of documents including copying, faxing and scanning incoming mail

Education/Experience:  High school diploma or equivalent.  Associate’s degree preferred.0-2 years of experience