Complaint and Appeals Senior Coordinator

As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate.

Requirements

• 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.
• Provide peer support to coordinators when handling complex appeal issues.
• Serves as SME for handling complex cases such as CA IPA or SIU cases.
• Maintain successful performance for meeting monthly metrics for attendance, production and quality.
• Provide training and ongoing support to new hires to ensure successful onboarding and integration into team processes.

Benefits

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