Appeal and Grievance Coordinator

• Intake, investigation and resolution of appeals, complaints and grievances scenarios
• Research incoming electronic appeals, complaints and grievance
• Research Standard Plan Design or Certification of Coverage
• Research claim processing logic
• Identify and research all components within member or provider/practitioner appeals
• Triage incomplete components to appropriate subject matter experts
• Coordinate all components of appeals including final communication
• Serve as technical resource to colleagues
• Identify trends and emerging issues

• Experience in reading or researching benefit language
• 1-2 years experience in claim platforms, products, and benefits
• patient management
• product or contract drafting
• compliance and regulatory analysis
• special investigations
• provider relations
• customer service or audit experience
• High School or GED equivalent
• Some college preferred

Experience in research and analysis of claim processing

• Affordable medical plan options
• 401(k) plan with matching company contributions
• Employee stock purchase plan
• Wellness screenings
• Tobacco cessation programs
• Weight management programs
• Confidential counseling
• Financial coaching
• Paid time off
• Flexible work schedules
• Family leave
• Dependent care resources
• Colleague assistance programs
• Tuition assistance
• Retiree medical access