Complaint and Appeals Coordinator

Job Summary

A company is looking for a Coordinator, Complaint & Appeals.

Key Responsibilities

• Manage resolution of complaint and appeal scenarios across multiple business units
• Review and process appeals filed by participating providers
• Draft and send appeal decision letters while ensuring compliance with regulatory requirements

Required Qualifications

• 1 year of experience with HMO and Traditional claim platforms, patient management, and compliance analysis
• Experience in provider relations, customer service, or audit
• High School diploma or equivalent