Complaint and Appeals Coordinator

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

Key Responsibilities

Manage resolution of complaint and appeal scenarios across multiple business units

Review and process appeals filed by participating providers

Draft and send appeal decision letters while ensuring compliance with regulatory requirements

Required Qualifications

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

Experience in provider relations, customer service, or audit

High School diploma or equivalent