Senior Coordinator Appeals Operations

Job Summary

A company is looking for a Senior Coordinator Complaint Appeals Operations, fully remote.

Key Responsibilities

• Manage resolution of complex appeal scenarios, coordinating responses from multiple business units
• Research and resolve incoming electronic appeals, acting as a subject matter expert on workflows and appeals processes
• Identify trends in misrouted work and deliver internal quality reviews while supporting audits and regulatory meetings

Required Qualifications

• 1-2 years of Medicare Part C Appeals experience
• 1 year of experience in reading or researching benefit language in SPDs or COCs
• 1 year of experience in research and analysis of claim processing
• High School Diploma
• Experience documenting workflows and reengineering efforts