Sr Coordinator, Complaints & Appeals Operations
Core
Process commercial member clinical appeals, complete determination letters, manage expedited requests, and support the panel hearing process.
Role type
Senior operational coordinator (clinical appeals)
Builds
Appeals determination letters and case tracking updates
Domain
Health insurance / Clinical operations
Deliverable
dashboards & analysis
Required skills
Medical terminology, written and 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, generate reports
Seniority
Senior, hands-on IC