Appeals & Grievances Coordinator - Remote

Overview

The Appeals & Grievances Coordinator will coordinate, process, and document member and provider appeals and grievances across various product offerings, ensuring timely resolutions and effective communication with stakeholders.

In Short

• Coordinate and document all aspects of member and provider appeals and grievances.
• Handle a large volume of incoming grievances and appeals.
• Ensure timely resolution of appeals within contractual timeframes.
• Document and track appeals in appropriate systems.
• Prepare reports for stakeholders and assist in external reviews.
• Work independently with members to resolve their appeals.
• Resolve payment and claims processing issues.
• Adapt to changing priorities in a dynamic environment.
• Strong customer service and communication skills required.
• Participate in quarterly team meetings at the office.

Requirements

• Bachelor's Degree in a related field preferred.
• 3-5 years of health plan experience.
• Strong aptitude for technology-based solutions.
• Excellent organizational abilities.
• Ability to prioritize tasks and meet deadlines.

Benefits

• Competitive base pay with comprehensive benefits.
• Career advancement opportunities.
• Recognition programs for contributions.
• Flexible work schedule with on-call components.