Appeals Coordinator

A company is looking for an Appeals & Grievances Coordinator to manage member and provider appeals and grievances.

Key Responsibilities

Coordinate, process, and document all aspects of member and provider appeals and grievances

Maintain tracking information and collaborate with internal and external parties to resolve cases

Compile reports for analysis and present cases to the Appeals Committee

Required Qualifications

Bachelor's Degree in a related field preferred, or equivalent experience

3-5 years of health plan experience, preferably in customer service or appeals and grievances

Strong understanding of health plan operations and relevant regulations

Proficiency in Microsoft Excel and Word

Ability to maintain professionalism in sensitive situations and adhere to confidentiality