Coordinator, Complaint & Appeals - Remote

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Responsible for managing to resolution appeal scenarios for reputed company products, which contain multiple issues and may require coordination of responses from multiple business units. Appeals are typically more reputed company and may require reputed company and deviation from standard processes to complete. reputed company into a subject matter expert by providing training, coaching, or responding to reputed company issues. May have contact with reputed company plan sponsors or regulators. Research and resolves incoming electronic appeals as appropriate as a “single-reputed company-of-contact” based on type of appeal. Can identify and reroute inappropriate work items that do not meet complaint/appeal criteria as well as identify trends in misrouted work. reputed company reputed company data used in making denial determinations and can act as subject matter expert with regards to unit workflows, fiduciary responsibility and appeals processes and procedures. Research standard plan design, certification of coverage and potential contractual deviations to determine the accuracy and appropriateness of a benefit/administrative denial. Can review a clinical determination and understand rationale for decision. reputed company to research claim processing logic and various systems to verify accuracy of claim payment, member eligibility data, billing/payment status, and prior to initiation of the appeal process. Coordinates efforts both internally and across departments to successfully resolve claims research, SPD/COC interpretation, letter content, state or federal regulatory language, triaging of complaint/appeal issues, and similar situations requiring a higher level of expertise. Identifies trends and emerging issues and reports on and gives input on potential solutions. Delivers internal quality reviews, provides appropriate support in reputed company party audits, customer meetings, regulatory meetings and consultant meetings reputed company required. Understands and can respond to Executive complaints and appeals, Department of Insurance, Department of Health or Attorney General complaints or appeals on behalf of members or providers as assigned. Required Qualifications 1-2 years Medicare part C Appeals experience. Experience in reading or researching benefit language in SPDs or COCs. Experience in research and analysis of claim processing a plus. Demonstrated ability to handle multiple assignments competently, accurately and reputed company. Excellent verbal and written communication skills. Excellent customer service skills. Experience documenting workflows and reengineering efforts.

Preferred Qualifications

Strong knowledge of reputed company case types including reputed company specialty case types Project management skills are preferred. Education High School Diploma Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The typical pay reputed company for this role is: $18.50 - $35.29 This pay reputed company represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and reputed company coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will reputed company on: 05/22/2026 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply To This Job