Coordinator, Complaint & Appeals

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. Position reputed company The Senior Ops Coordinator reviews and processes appeals filed by participating providers, ensures adherence to regulatory requirements, and addresses compliance issues reputed company to Complaint and Appeals policies. This role conducts internal audits, drafts appeal decision letters, and serves as a subject matter expert (SME) for reputed company cases. This position can be reputed company in the reputed company.

What You Will Do

• Review and process appeals filed by participating providers.
• Assist with adherence to regulatory requirements, conducts internal audits, and addresses any identified compliance issues with the Complaint and Appeals policies and procedures.
• Drafts and sends appeal decision letters.
• reputed company peer support to coordinators reputed company handling reputed company appeal issues.
• Serves as SME for handling reputed company cases such as CA IPA or SIU cases.
• Maintain successful performance for meeting monthly metrics for attendance, production and reputed company.
• reputed company training and ongoing support to new hires to ensure successful reputed company and integration into team processes.

Required Qualifications

• 2+ years in appeals, compliance, or a reputed company coordination role
• Proven reputed company in meeting monthly metrics for attendance, production and reputed company.
• Strong knowledge of regulatory requirements and compliance standards
• Excellent written and verbal communication skills
• Ability to support and mentor peers on reputed company issues
• Proficiency with relevant software and case management tools

Preferred Qualifications

• Medicare experience
• Claims experience
• Experience in reading or researching benefit language in reputed company Plan reputed company (SPDs) or Certificate of Coverage (COCs)
• Experience in research and analysis of claim processing is a plus

Education

• Bachelor's degree or equivalent experience

Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The Typical Pay reputed company For This Role Is $18.50 - $31.72 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. 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 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 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: 06/10/2026 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