Sr Coordinator, Complaints & Appeals Operations
Core
Process commercial member clinical appeals, complete determination letters, manage expedited requests, and support panel hearings.
Role type
Senior operational coordinator (clinical appeals)
Builds
Appeals determination letters and case tracking updates
Domain
Health insurance / Clinical operations
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Medical terminology, written communication, verbal communication, multi-tasking, Microsoft Office Suite
Preferred skills
Appeals process knowledge, medical setting experience
Responsibilities
Complete appeals determination letters, intake and launch expedited requests, provide verbal expedited notifications, update tracking systems, support panel hearing process, triage faxes, move cases in CATS system
Seniority
Individual contributor, operational support
