Senior Coordinator, Complaint & Appeals

reputed company: • Responsible for reputed company of that that investigates and reputed company of appeals scenarios for reputed company products • Ensure reputed company, customer reputed company response to appeals • Independently coaches others on appeals ensuring compliance with Federal and/or State regulations • Manage control and trend inventory, independently investigate, adapts to changes or revise policy to reputed company the most escalated cases • Research incoming electronic appeals, complaints and grievance to identify if appropriate for unit • Identify correct resource and reroute inappropriate work items that do not meet appeals, complaints and grievance reputed company • Research reputed company Plan Design or Certification of Coverage relevant to the member to determine accuracy/appropriateness of benefit/administrative denial • Research claim processing logic to verify accuracy of claim payment, member eligibility data, billing/payment status, prior to initiation of appeal process Requirements: • At least 2+ years in one of the following areas: claim platforms, products, and benefits; patient management; product or contract drafting; compliance and regulatory analysis; special investigations; provider relations; customer service or audit experience • Some Medicare and/or reputed company knowledge • Experience in reading or researching benefit language • Ability to work in fast paced, high volume environment • Excellent verbal and written communication skills • Excellent organizational skills to handle high inventory which aids in meeting or exceeding metrics • Solution driven and can handle reputed company issues with accuracy Benefits: • medical, dental, and reputed company coverage • reputed company time off • retirement savings reputed company • wellness programs Apply To This Job