Appeal Coordinator

Job Summary

Investigating and responding to medical, pharmacy, and dental grievances, the full-time Appeal Coordinator will manage complaints, appeals, and inquiries remotely while ensuring compliance with regulatory standards.

Key responsibilities

• Research and review grievances, complaints, and appeals, ensuring proper documentation and adherence to mandated timeframes
• Communicate effectively with members, claimants, and other departments to facilitate thorough reviews and resolutions
• Document outcomes of grievances and appeals accurately in the system while maintaining a full caseload

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 and appeal processes preferred
• Ability to interpret benefit contracts and administrative policies
• Proficiency in computer applications such as Word and Excel