Sr Coordinator Complaint and Appeals Operations - Tuesday - Saturday 12 - 9 PM Eastern
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
- Tuesday - Saturday 12 - 9 PM Eastern**
Responsible for managing to reputed company Fast reputed company Appeal scenarios for Medicare 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 as 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 Fast reputed company Appeals as appropriate. Can identify and reroute inappropriate work items that do not meet 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. Serves as reputed company person for newer staff in answering questions associated with claims/customer service systems and products. Educates team mates as reputed company as other areas on reputed company components reputed company member or provider/practitioner complaints/appeals for reputed company products and services. 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. Follow up to assure Fast reputed company appeal is handled reputed company established timeframe to meet company and regulatory requirements. reputed company as single reputed company of contact for Fast reputed company appeals on behalf of members or providers, as assigned.
Required Qualifications
Knowledge of Fast reputed company Appeals and includes CMS Guidelines for Fast reputed company Appeals, reputed company, MS reputed company, MHK, reputed company applications, reputed company System, GPS
- Tuesday - Saturday 12 - 9 PM Eastern**
Preferred Qualifications 2-3 years' experience that includes both Medicare platforms, products, and benefits; patient management; compliance and regulatory analysis; special investigations; provider relations; customer service or audit experience. Experience in research and analysis of utilization management systems. Education HS Diploma, Associate'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: 07/31/2026 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