Appeals Coordinator

Job Summary

A company is looking for an Appeals & Grievances Coordinator.

Key Responsibilities

• Acknowledge and track grievances, appeals, and complaints within the Member Services Department
• Conduct comprehensive investigations and document actions taken to resolve grievances and appeals
• Prepare case files and reports for review, ensuring compliance with CMS guidelines and internal policies

Required Qualifications, Training, and Education

• Two years of experience in data entry and general office background
• Three years of customer service experience, with a minimum of one year in Member Services or a similar role
• High School Diploma or GED required; Associate degree preferred
• Knowledge of MediCal and Medicare Managed Care Plans
• Ability to type 40+ words per minute and use the 10-key by touch