Member Appeals Coordinator

Job Summary

A company is looking for a Member Appeals and Grievances Coordinator, Remote in Virginia.

Key Responsibilities

• Investigate and document member appeals and grievances in compliance with state laws and regulations
• Collaborate with the Plan's Medical Directors on clinical appeals and the Appeals Manager on non-clinical appeals
• Ensure adherence to provider and group agreements during the appeals process

Required Qualifications

• High School Graduate or equivalent
• Minimum of 3 years of experience in managed care
• Previous experience with member appeals and grievances is preferred
• No specific certification or licensure required