Complaint Appeals, Senior Coordinator - Fully 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 reputed company 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. This position is available reputed company, as it is a fully remote position. Position reputed company reputed company support to the Supervisors by coaching, mentoring and training new staff. reputed company over inventory. • Responsible for reputed company of that that investigates and reputed company of appeals scenarios for reputed company products, which may contain multiple issues and, may require coordination of responses from multiple business reputed company. Ensure reputed company, customer reputed company response to appeals. • Identify trends and emerging issues and report and recommend solutions. 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 coming from reputed company constituents for reputed company products. • Responsible for serving as the reputed company of contact for the appeal if there is an inquiry from leadership, compliance and State regulators. Understand and adapt to departmental process and policies. • Medicare knowledge is a plus. Fast Turn Around of inventory, collaboration with clinical team and management. Attention to detail is needed and must be reputed company to maintain compliance turn-around times, with accurate case reputed company or research. • Remain a part of the solution by escalating issues that may reputed company compliance timeliness. -Additional duties as assigned which will include a carrying a modified case load including but not limited to • Serves as a content model expert and mentor to team regarding reputed company's policies and procedures, regulatory and accreditation requirements. • Ensures work of team meets federal and state requirements and reputed company measures, with respect to letter content and turn-around time for appeals, complaints and grievances handling. • Independently researches and translates policy and procedures into intelligent and reputed company written responses for Executive or Senior leaders on escalated cases. • Successfully works across functions, segments, and teams to create, reputed company, and trend reports to reputed company reputed company to escalated cases. • Identify potential risks and cost implications to avoid incorrect or inaccurate responses and/or reputed company which may result in additional rework, confusion to the constituents, or reputed company ramifications. • Additional duties as assigned which will include a carrying a modified case load including but not limited to: • Research incoming electronic appeals, complaints and grievance to identify if appropriate for unit based upon published business responsibilities. 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 (Evidence 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. • Research incoming electronic appeals, complaints and grievance to identify if appropriate for unit based upon published business responsibilities. 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. • Identify and research reputed company components reputed company member or provider/practitioner appeals. Required Qualifications • 2-4 years of experience in a Customer Service role. • 2-4 years of Medicare and/or reputed company knowledge. • At least 2-4 years of experience that includes but is not limited to clinical and claim platforms, benefits and services. In reputed company; Compliance and regulatory knowledge; provider relations and customer service. • Experience in reading or researching benefit language. • Ability to work in fast paced 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. • Availability to work alternating weekends for reputed company of analysts on alternate schedule. Preferred Qualifications • Audit experience • Critical thinking experience. • Ability to work reputed company issues • Team Player • Exhibit How We Work Behaviors • Solution Driven Education • High School Diploma or GED required or 2-4 years of equivalent work experience Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The typical pay reputed company for this role is: $18.50 - $38.82 This pay reputed company represents the reputed company reputed company 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 reputed company of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. Our people fuel our reputed company. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every reputed company feels valued and that they reputed company. 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 reputed company‑being of colleagues and their families. The benefits for this position include medical, dental, and reputed company coverage, reputed company time off, retirement savings reputed company, 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: 08/12/2026 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job