Appeals Coordinator

Responsible for managing the day-to-day functions of grievances and appeals, the full-time remote Appeals Coordinator will investigate, document, and resolve member and provider complaints while ensuring compliance with CMS guidelines. Key responsibilities Acknowledge and track grievances and appeals, ensuring timely resolution and documentation Conduct comprehensive investigations and compose written correspondence in accordance with policies and guidelines Prepare case files for review and identify opportunities for process improvements related to grievance data Required qualifications High School Diploma or GED required; Associate degree preferred Two years of data entry and general office experience Three years of customer service experience, with at least one year in Member Services or a similar role Knowledge of MediCal and Medicare Managed Care Plans Ability to type 40+ words per minute and use the 10-key by touch