Appeals Coordinator

Job Summary

Responsible for reviewing, researching, and resolving appeals, the full-time Appeals Coordinator will ensure compliance with regulations and standards while managing appeal documents and communications in a remote environment.

Key responsibilities

• Reviews, evaluates, documents, and tracks appeal documents, ensuring timely resolution
• Creates and provides quality written responses to appeals requests within established time standards
• Communicates with members and providers regarding appeal resolutions and prepares case files for Independent Review Entities

Required qualifications

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