Appeal Coordinator

Job Summary

A company is looking for an Appeal Coordinator I to investigate and respond to medical, pharmacy, and dental grievances, complaints, appeals, and inquiries.

Key Responsibilities

• Research and review grievances, complaints, and appeals, ensuring appropriate documentation and timely responses
• Communicate with members, claimants, and providers regarding claims and policies, and interpret contracts as needed
• Maintain a full caseload while meeting established production and accuracy standards for case completion

Required Qualifications

• High School diploma or equivalent
• 6 months to 2 years of experience in medical/dental claims processing or customer service preferred
• Knowledge of CMS rules for Medicare and Medicaid grievance processes preferred
• Ability to interpret benefit contracts and administrative policies
• Proficiency in computer applications such as Word and Excel