Appeals Coordinator

Job Summary

Working remotely in a full-time capacity, the Appeals Coordinator will manage the tracking and trending of grievances, appeals, and complaints within the Member Services Department, acting as the primary investigator and contact for member and provider issues.

Key responsibilities

• Acknowledge receipt of grievances and appeals, gathering relevant information to determine resolutions
• Conduct comprehensive investigations and document all actions taken to resolve issues in compliance with CMS guidelines
• Prepare case files and reports for review, identifying training opportunities and process improvements related to grievance data

Required qualifications

• High School Diploma or GED; Associate degree preferred
• Two years of experience in data entry and general office work, along with three years of customer service experience
• Knowledge of MediCal and Medicare Managed Care Plans
• Ability to type 40+ words per minute and effectively communicate with diverse members and stakeholders
• Problem-solving and organizational skills, with the ability to work in a fast-paced environment