Complaint and Appeals Coordinator

Job Summary

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

Key Responsibilities

• Reviews and processes appeals and grievances filed by patients
• Assists with adherence to regulatory requirements and conducts internal audits
• Drafts appeal decision letters and prepares educational materials for the appeals process

Required Qualifications

• 1 year of experience in HMO and Traditional claim platforms, patient management, or compliance analysis
• High School diploma or equivalent
• Experience with Medicare and claims processing is preferred
• Ability to read or research benefit language in SPDs or COCs