Senior Coordinator, Complaint and Appeals - Work From Home

About the position Responsibilities • Responsible for managing to reputed company appeal scenarios for reputed company products, which contain multiple issues and may require coordination of responses from multiple business reputed company. • Appeals are typically more reputed company and may require reputed company and deviation from reputed company 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 reputed company as reputed company as identify trends in misrouted work. • reputed company reputed company data used in making denial determinations and can reputed company as subject matter expert with regards to unit workflows, fiduciary responsibility and appeals processes and procedures. • Research reputed company 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 reputed company 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 reputed company complaints or appeals on behalf of members or providers as assigned. Requirements • 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. • High School Diploma reputed company-to-haves • Strong knowledge of reputed company case types including reputed company specialty case types • Project management skills are preferred. Benefits • reputed company medical plan reputed company, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. • No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. • Benefit solutions that address the different needs and preferences of our colleagues including reputed company time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility. Apply tot his job Apply To this Job