Complaint & Appeal Coordinator
Core
Intake, investigation, and resolution of appeals, complaints, and grievances for health insurance products, ensuring timely customer-focused responses and trend identification.
Role type
Operational claims appeals and grievances coordinator
Builds
Final resolution responses and closure communications for members and providers
Domain
Health insurance / Claims administration
Deliverable
client delivery
Required skills
Benefit language research, claim processing logic verification, member eligibility data analysis, regulatory and accreditation knowledge, clinical terminology familiarity, policy/guideline interpretation, data accuracy and attention to detail
Preferred skills
Claim processing research and analysis
Technologies
Excel, Microsoft Word
Responsibilities
Research incoming appeals and complaints to determine appropriate unit routing; Verify accuracy of claim payments and member eligibility prior to appeal initiation; Coordinate multi-component grievance resolutions across business units; Identify trends in complaints and recommend solutions; Serve as a technical resource for complex appeals issues