Appeals Coordinator

Appeal & Grievance Coordinator Reviewer - Appeals Support


Location: Phoenix, AZ

Schedule: Monday-Friday, 40 hours/week

Contract: September 14, 2026 - December 31, 2026

Openings: 2
$20/hour
100% on-site

Position Overview


Seeking an Appeal & Grievance Coordinator Reviewer to support medical and pharmacy appeals and grievances. This role involves researching cases, reviewing medical records and claims information, documenting findings, correcting account information, and ensuring cases are processed accurately and within applicable regulatory timeframes.

Key Responsibilities

• Research and review medical and pharmacy appeals, grievances, and related documentation.
• Analyze medical records, claims, coverage guidelines, and historical information to support case resolution.
• Verify documentation for completeness and identify missing or insufficient information.
• Process appeals and grievances accurately while meeting required State, Federal, and accreditation timelines.
• Perform data corrections, claim adjustments, and system updates based on final determinations.
• Communicate with members, providers, internal departments, vendors, and other stakeholders regarding case information.
• Identify trends and recurring issues within appeals, grievances, and documentation and report findings to management.
• Assist with quality audits, aging reports, case assignments, and claims-related inquiries.
• Support Level 1 reviewers through questions, training, mentoring, and development of job aids and procedures.
• Maintain accurate records and protect confidential health information in accordance with HIPAA requirements.
• Assist with pharmacy appeals, external cases, and required documentation.
• Complete required training and maintain current knowledge of applicable healthcare, claims, appeals, and grievance requirements.

Required Qualifications

• High school diploma or equivalent.
• At least 1 year of experience in claims processing, medical/pharmacy precertification, appeals and grievances, or related healthcare/insurance operations.
• Strong analytical, research, and problem-solving skills.
• Intermediate computer skills, including Microsoft Word, Excel, databases, and standard office equipment.
• Strong written and verbal communication skills.
• Ability to interpret and apply policies, procedures, benefits, and regulatory guidelines.
• Ability to maintain confidentiality and handle protected health information.
• Strong attention to detail and ability to manage multiple cases and deadlines.

Preferred Qualifications

• 2+ years of experience in a senior or lead claims role.
• 3+ years of experience working with claims processing and multiple claims systems.
• 2+ years of healthcare or medical industry experience.
• Pharmacy technician or precertification experience.
• Bachelor's degree in healthcare, business, or a related field.
• Certified Coder certification.
• Experience with claims processing logic, healthcare benefits, and administrative guidelines.

Ideal Candidate


The ideal candidate is detail-oriented, analytical, organized, and comfortable researching complex healthcare cases . Strong customer service, documentation, communication, and computer skills are essential, along with the ability to work independently while collaborating effectively with clinical, claims, legal, and administrative teams. #IND1