Appeals Coordinator

Job Summary

Responsible for reviewing, researching, and resolving appeals, the full-time Appeals Coordinator will ensure compliance with regulations and guidelines while communicating with members and providers, all in a remote work environment.

Key responsibilities

• Reviews, evaluates, and tracks appeal documents, ensuring resolution within established time standards
• Creates quality written responses to appeals requests and prepares case files for Independent Review Entities
• Communicates effectively with members and providers regarding appeal resolutions and performs peer QA of appeal notification letters

Required qualifications

• High School diploma or equivalent
• 1+ years of experience in appeals or related field
• Strong learning agility and enthusiasm for skill development
• Proficiency in Microsoft Word, Excel, PowerPoint, and Outlook
• Ability to maintain confidentiality and adapt to changing priorities