Complaint and Appeals Coordinator

Job Summary

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

Key Responsibilities

• Manage complaint and appeal scenarios for various products, ensuring timely and customer-focused responses
• Coordinate responses from multiple business units to resolve complex issues
• Identify trends and emerging issues, reporting and recommending solutions

Required Qualifications

• 1 year of experience with HMO and Traditional claim platforms, patient management, and compliance analysis
• Experience in special investigations, provider relations, customer service, or audit
• High School diploma or equivalent
• Preferred experience in Medicare and claims processing
• Experience in reading or researching benefit language in Summary Plan Descriptions or Certificates of Coverage