Solis Health Plans · 20 hours ago
Grievance & Appeals Specialist
Doral, FL, US
Full-time
Onsite
Entry, Mid Level
$22/hr - $24/hr
2+ years expSolis Health Plans is a new kind of Medicare Advantage Company that focuses on providing transparent and effective healthcare solutions. The Grievance & Appeals Specialist will facilitate the grievance and appeal process, ensuring compliance with regulatory requirements and providing support to members and providers throughout their healthcare journey.
Health CareHealth DiagnosticsPersonal Health
Responsibilities
Respond to complaints, grievances and appeals in a consistent fashion, adhering to all regulatory, accreditation and internal processing timelines and guidelines
Conducts investigation and review of customer grievances and appeals
Communicate with members or providers to gather information and communicate disposition of case, documents interactions
Generate written correspondence to customers such as members, providers and regulatory agencies
Track and monitor movement of assigned cases through functional units and systems, to ensure compliance with designated timelines
Summarizes and presents essential information for the clinical specialist or medical director and legal counsel
Ensures appropriate resolution to inquiries, grievances and appeals within specified timeframes established by either regulatory/accreditation agencies or customer needs
Identifies barriers to customer satisfaction and recommends actions to address operational challenges
Manage the increasing volume of MAPD grievances and Appeals, CTMs, and member emails
Full case ingestion and oversight from receipt through resolution and will be responsible times and ensure compliance with CMS regulatory requirements
Responsible for logging and reporting cases from G/A portal
Additional Responsibilities as needed
Qualification
Required
Must be Bilingual in English and Spanish
Requires a High School diploma/GED
2-4 years' experience in customer service, preferably in a managed care environment, medical office or health insurance; or any combination of education and experience, which would provide an equivalent background
Ability to organize work, set and manage multiple priorities and assigned G&A cases in a time sensitive manner
Basic work processing, database management and spreadsheet skills required
Strong computer skills, typing skills: Proficiency with Microsoft Word/Outlook required
Good verbal and written communication, organizational and interpersonal skills required
Strong telephone, oral communication and customer service skills required. Must be able to diffuse difficult situations
Preferred
Prior experience working in Grievance & Appeals preferred
Claims knowledge a plus
Benefits
Medical
Dental
Vision
401K plan with a 100% company match!
Company
Solis Health Plans
Solis Health Plans is a medicare firm that deals with healthcare solutions and plans.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Efrain Duarte
Chief Executive Officer
Michael Lynch
Chief Financial Officer
Recent News
2025-04-15
Company data provided by crunchbase