Complaint and Appeals Coordinator

A company is looking for a Coordinator, Complaint & Appeals (Remote).

Key Responsibilities

Reviews and processes appeals and grievances filed by patients

Conducts internal audits and addresses compliance issues related to Complaint and Appeals policies

Prepares educational materials and coaches junior colleagues on best practices

Required Qualifications

1 year of experience in HMO and Traditional claim platforms, patient management, or compliance analysis

High School diploma or equivalent

Experience with Medicare and claims processing is preferred

Ability to read and research benefit language in Summary Plan Descriptions or Certificates of Coverage

Experience in conducting research and analysis of claims processing is a plus