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

Assists with adherence to regulatory requirements and conducts internal audits

Drafts appeal decision letters and prepares educational materials for the appeals process

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 or research benefit language in SPDs or COCs