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The Appeals Representative Associate
is responsible for providing expertise or general support to teams in
reviewing, researching, investigating, negotiating and resolving all
types of appeals and grievances.
- Research and resolve written complaints and complex
or multi-issue provider complaints submitted by consumers and
- Communicate with appropriate parties regarding appeals and grievance issues, implications and decisions
- Analyze and identify trends for appeals and grievances
- Apply knowledge/skills to basic, repeated activities
- Respond to standard requests and solve routine problems by following established procedures
- Work with others as part of a team and have work reviewed by others