Appeals and Grievance Coordinator

Job Summary

Managing and resolving member and provider complaints, the fully remote Appeals and Grievance Coordinator will coordinate grievances and appeals, ensuring compliance with regulatory requirements while acting as the primary investigator and contact person.

Key responsibilities

• Send acknowledgments of grievances/appeals and educate members or providers about the process
• Gather relevant information to determine appropriate resolutions per standard policies and procedures
• Conduct thorough investigations and document all actions taken to resolve grievances/appeals

Required qualifications

• Experience in managing complaints, grievances, or appeals in a healthcare setting
• Knowledge of state and federal regulatory requirements related to grievances and appeals
• Strong analytical skills for conducting investigations and resolving issues
• Proficient in documentation and maintaining accurate records
• Ability to work independently in a fully remote environment