Massachusetts Licensed Appeals Coordinator

Job Summary

A company is looking for a Member Advocate, Appeals and Grievance Coordinator.

Key Responsibilities:

• Document and track all inbound grievances, appeals, and coverage determinations
• Ensure compliance with CMS guidelines for processing and timeliness of grievances and appeals
• Facilitate coordination with internal and external customers to resolve cases satisfactorily

Required Qualifications:

• 3-5 years of customer service experience
• Knowledge of Medicare and Medicare Advantage is preferred
• Bachelor's degree or relevant experience
• Ability to handle complex and confidential matters discreetly
• Experience presenting case files during internal and CMS audits