Member Appeals Coordinator

Job Summary

Working remotely in Virginia, the full-time Member Appeals Coordinator will manage the investigation and documentation of member appeals and grievances in compliance with state laws and regulations while collaborating with medical directors and the appeals manager.

Key responsibilities

• Investigate and document member appeals and grievances in accordance with state laws and regulations
• Collaborate with the Plan's Medical Directors on clinical appeals and grievances
• Work closely with the Appeals Manager on non-clinical appeals and grievances

Required qualifications

• High School diploma or equivalent
• Minimum of 3 years of experience in managed care
• Previous experience with member appeals and grievances is preferred
• Experience with JIVA and Medicaid is preferred
• No specific certifications or licensure required