Sr. Grievance and Appeals Administrator job in Portland, OR

Sr. Grievance and Appeals Administrator

Title: Sr. Grievance and Appeals Administrator Location: Portland, OR Decrease plan exposure to bad faith or breach of contract law suits, regulatory sanctions, employer-group penalties and adverse media by effectively resolving complaints, grievances and appeals region-wide in compliance with federal/state/contractual laws/regulations, plan policy and legal principles; enhance employer-group retention through resolution of complex or sensitive complaints, advise Care Delivery managers working with difficult customers to ensure contractual and legal requirements are met, promote member retention and reduce plan liability. Essential Functions: - Adjudicate customer grievances, appeals and exception requests; assess plan obligation and potential risk; comply with federal/state and...

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from Oregon Employment Department - 4 days ago