Appeal Coordinator I

Job Summary

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

Key responsibilities

• Research and review grievances, complaints, and appeals, ensuring proper documentation and adherence to timelines
• Communicate effectively with members, claimants, and other departments regarding claims and policies
• 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, complaint, and appeal processes preferred
• Ability to interpret benefit contracts and administrative policies
• Proficiency in computer applications such as Word and Excel
• Strong typing skills with a minimum of 25 wpm accurately on a computer keyboard