Lead Specialist, Appeals & Grievances

JOB DESCRIPTION Job Summary Provides lead level support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS).

Essential Job Duties

• Serves as team lead for submission, intervention and resolution of appeals, grievances, and/or complaints from Molina members, providers and related outside agencies.
• Trains new employees and provides guidance to others with respect to complex appeals and grievances.