Grievance & Appeals Associate - Full-time / Part-time

Appeal & Grievance Coordinator – Monterey Park, CA Kelly Services, a global leader in staffing solutions, is seeking Appeals & Grievance Coordinators with an industry-leading health insurance client in the Monterey Park, CA area!    Start Date: April 1st -July 1, 2019 with the possibility to extend and turn into a full-time opportunity Job Description: Receive cases from Member Services, and via email/fax. Intake reviews cases and assigns to the Coordinator. Read complaint, call Member to introduce themselves, and confirm details of the case. Document the call and investigation, and resolution. Contact Member, and provide Member the resolution. Write a Resolution Letter to member outlining how the complaint/appeal was resolved. Researches and resolves member/subscriber grievances, appeals and complaints, and interprets and explains health plan benefits, policies and procedures to respondents. Researches, reviews and resolves high level/high priority member grievances, appeals and complaints, while clarifying issues and educating customers in the process. Interprets and explains health plan benefits, policies, procedures and functions to members and providers. Produces complex written correspondence to resolve member grievances, appeals and complaints. Administers ongoing grievance tracking, trending and reporting for assigned grievances. Evaluates all grievances for trend purposes and reports periodic and ad hoc trends to Risk and Quality Management departments. Coordinates next level grievance/appeal meeting with appropriate parties and forwards documentation to the review committee. Establishes and maintains cohesive relationships with assigned IPA partners through telephone, field work and written communication. Education/ Minimum Requirements: High School Diploma or GED Grievance and Appeals experience is REQUIRED. At least 2 years of experience. Healthcare (MediCal and Medicare) experience required. At least 2 years of experience Hours: Training: Classroom training for 2 weeks. Training will either be 8am to 4:30pm or 8:30am to 5:00pm. Schedule after training: 8:30am to 5:00pm. Apply Today! Important information: This position is recruited for by a remote Kelly office, not your local Kelly branch. Please submit your resume to be considered for this position.   If you have questions about the opening, you may contact the recruiter for this position at matthsy @ kellyservices.com. Why Kelly? As a Kelly Services candidate you will have access to numerous perks, including: • Exposure to a variety of career opportunities as a result of our expansive network of client companies  • Career guides, information and tools to help you successfully position yourself throughout every stage of your career • Access to more than 3,000 online training courses through our Kelly Learning Center • Group-rate insurance options available immediately upon hire (Available for purchase and administered by a designated third-party vendor) • Weekly pay and service bonus plans We invite you to bookmark our Web site and encourage you to review it regularly for new opportunities worldwide:  www.kellyservices.com . Kelly Services® is a U.S.-based Fortune 1000 company. With our global network of branch locations, we are uniquely positioned to provide our customers with international staffing support and our employees with diverse assignments around the world. Kelly Services is an Equal Opportunity Employer.   Why Kelly ® ? At Kelly Services ® , we work with the best. Our clients include 95 of the Fortune 100 ™ companies, and more than 70,000 hiring managers rely on Kelly annually to access the best talent to drive their business forward. If you only make one career connection today, connect with Kelly. About Kelly Services ® As a workforce advocate for over 70 years, we are proud to directly employ nearly 500,000 people around the world and have a role in connecting thousands more with work through our global network of talent suppliers and partners. Revenue in 2017 was $5.4 billion. Visit kellyservices.com and connect with us on Facebook , LinkedIn and Twitter . Kelly Services is an equal opportunity employer including, but not limited to, Minorities, Females, Individuals with Disabilities, Protected Veterans, Sexual Orientation, Gender Identity and is committed to employing a diverse workforce. Equal Employment Opportunity is The Law.