Grievance and Appeals Coordinator

Description
Who We Are
WPS Health Solutions is a leading not-for-profit health insurer and federal government contractor headquartered in Wisconsin. WPS offers health insurance plans for individuals, families, seniors, and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS Health Solutions has been making health care easier for the people we serve for more than 75 years. Proud to be military and veteran ready.
Culture Drives Our Success
WPS Culture is where the great work and innovations of our people are seen, fueled, and rewarded. We accomplish this by creating an inclusive and empowering employee experience. We recognize the benefits of Diversity, Equity, and Inclusion as an investment in our workforce-both current and future-to effectively seek, leverage, and include diverse perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities.
We are proud of the recognition we have received from local and national organization regarding our culture and workplace: WPS Newsroom – Awards and Recognition
Role Snapshot
As a Grievance and Appeals Coordinator, you will investigate and resolve complex patient and insurance provider complaints related to claims, enrollment, medical authorization denials, within the healthcare industry. You will create training for new staff on appeals and develop a process for feedback for all areas in the division. Reporting processes will be created and maintained in this role to support the overall savings for the company while maintaining the membership and provider support of our company.
How do I know this opportunity is right for me? If you:
Have efficient researching and investigative skills.
Can communicate with confidence, clarity and sound reasoning when resolving an issue.
Are a self-starter, work independently, and can reprioritize as new situations arise.
Have experience with regulatory information and are familiar with healthcare data such as PHI and PII.
Have strong skills and technical acumen that could include the following skillsets: computer navigation and working within multiple applications, telephone support, letter writing and composition, project management.
Have strong organizational skills and documentation.
Are able to learn new products and processes.
Want to be an innovator helping to bring process improvements and develop reporting and tracking strategies.
Approach situations with empathy and adaptability in mind.
What will I gain from this role?
Deep understanding of the WPS certificates and Medical Policies.
Hands on experience in resolving grievances and appeals for our members.
The opportunity to participate in professional development and training.
Independence to solve problems investigate issues and utilize sound decision making skills constantly.
Knowledge and participation of audits with Utilization Review Accreditation Commission (URAC).
Working on a diverse team environment of clinical staff including Nurses, Medical Directors, Quality and Intake Specialists.
Opportunities to learn, train and create process improvements and best practices to the division.
Experience working in an environment that serves our nations military, veterans, Guard and Reserves, and Medicare beneficiaries.
Working in a continuous performance feedback environment.
Minimum Qualifications
High School Diploma or equivalent.
2 or more years of related work experience within healthcare, insurance or appeals.
Preferred Qualifications
Experience working in a regul