Appeals Coordinator

Job Summary

Responsible for managing the day-to-day functions of grievances and appeals, the full-time remote Appeals Coordinator will investigate, document, and resolve member and provider complaints while ensuring compliance with CMS guidelines.

Key responsibilities

• Acknowledge and track grievances and appeals, ensuring timely resolution and documentation
• Conduct comprehensive investigations and compose written correspondence in accordance with policies and guidelines
• Prepare case files for review and identify opportunities for process improvements related to grievance data

Required qualifications

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