Senior Coordinator , Complaint and Appeals - must reside in Ohio
Core
Prepares, researches, and evaluates information to resolve member complaints, appeals, and grievances for health plans.
Role type
Senior Coordinator, Complaint and Appeals
Builds
Accurate, timely, and compliant case resolutions for member grievances
Domain
Healthcare / Insurance / Claims
Deliverable
client delivery
Required skills
Analytical skills, Problem-solving, Decision-making, Written communication, Verbal communication, Microsoft Office proficiency
Preferred skills
Healthcare experience, Insurance experience, Claims experience, Customer service experience, Knowledge of health plan benefits, Knowledge of appeals processes
Responsibilities
Reviews and investigates member complaints, appeals, and grievances; Analyzes case information and benefit data to determine outcomes; Prepares written correspondence for determinations; Maintains case documentation; Identifies process trends and escalates issues; Supports regulatory compliance