Senior Coordinator, Complaint and Appeals

This is a fully remote position, open to applicants in Ohio.

📋 Description

• Review and assess member complaints, appeals, and grievances in alignment with established policies and procedures.

• Evaluate case details, supporting documentation, and benefit information to ascertain suitable case resolutions.

• Draft precise and timely written communication regarding complaint and appeal outcomes.

• Ensure cases are managed within defined quality, productivity, and turnaround time benchmarks.

• Investigate and address complex issues by collaborating with internal business partners and relevant stakeholders.

• Maintain accurate and thorough case records in relevant systems.

• Identify potential trends or process issues and escalate concerns as necessary.

• Engage in departmental projects, training, and initiatives aimed at process improvement.

• Ensure adherence to federal and state regulations, as well as internal policies governing complaint and appeal processes.

⛳️ Requirements

• A minimum of 5 years of experience in Medicaid Complaint & Appeals.

• Strong analytical, problem-solving, and decision-making abilities.

• Exceptional written and verbal communication skills.

• Capability to manage multiple priorities while meeting established deadlines.

• Proficiency in Microsoft Office applications.

• High school diploma or equivalent is mandatory.

• Preferred experience in healthcare, insurance, claims, customer service, complaints and appeals, or related operations.

• Preferred experience in researching and resolving complex customer or member issues.

• Preferred knowledge of health plan benefits, claims, and appeals processes.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being, subject to eligibility.