Government Programs Appeal Coordinator

Job Summary

Investigating and responding to medical, pharmacy, and dental grievances, the full-time Government Programs Appeal Coordinator will manage appeals and inquiries while working remotely.

Key responsibilities

• Research and review grievances, complaints, and appeals, ensuring appropriate documentation and compliance with mandated timelines
• Communicate effectively with members, claimants, and other departments to facilitate fair reviews and responses
• Interpret benefit contracts and respond to independent review entity requests, maintaining accurate documentation of case outcomes

Required qualifications

• High School diploma or equivalent
• 6 months to 2 years of experience in medical/dental claims processing or customer service preferred
• Knowledge of CMS rules for Medicare and Medicaid grievance processes preferred
• Ability to interpret benefit contracts and administrative policies
• Proficiency in computer applications such as Word and Excel