Appeals and Grievances Administrator

**Responsibilities:**

The primary purpose of the job is to: Under the general supervision of the Supervisor of Grievances, CTM and Critical Incidents, this position screens calls from members and providers regarding the Part C, Part D and Medicare-Medicaid Plan grievance processes. In addition, the Administrator will serve as a backup so when needed they will be responsible for retrieving grievances from the Customer Service database and email distribution lists and assign them appropriately to Grievance Investigators. Will support grievance needs of our Medicare Advantage D-SNP and MMP membership.

+ Complete First Call Resolution cases, including intake, determining if case is fully resolved, generate letters and close case. If cases are not fully resolved, convert to standard grievance and assign to an investigator.
+ Generating Acknowledgement Letters to mail to appellants and answering general appeal status questions.
+ Assisting Investigation Specialists w...