Appeals Coordinator

Tailored Management; United States; Remote; USD 10,000 - 60,000; Full time

Job summary

A leading company is seeking an Appeals Coordinator to manage and organize appeals processes while ensuring compliance with regulations. This fully remote position requires strong analytical and communication skills, with a focus on effective customer service in the health insurance sector.

Benefits

Medical insurance

Vision insurance

Qualifications

• 2 years experience in health insurance claims inquiries or equivalent.
• Effective analytical, problem solving, research, and organizational skills.
• Strong verbal and written communication skills.

Responsibilities

• Process and coordinate appeals according to requirements.
• Respond to inquiries regarding appeals via various methods.
• Coordinate appeal functions and prepare reports.

Skills

Analytical skills

Problem solving

Organizational skills

Communication skills

Job description

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Tailored Management provided pay range

This range is provided by Tailored Management. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$20.00/hr - $22.00/hr

Pay Rate: $22/hr on w2

Location: Fully remote

Schedule: Monday-Friday, standard business hours

Assignment Length: through December 2025, potential for extension/conversion depending on performance, attendance and business need

Target Start Date: ASAP, pending completion of new hire onboarding

Role Overview:

Under supervision, this position is responsible for processing, organizing, and coordinating all materials and information relating to processing appeals for all lines of business following federal, state, and accreditation requirements; and for accurately responding by telephone, in person, or through correspondence to all inquiries involving requests for appeals from members, the Department of Labor, or ERISA; sending acknowledgement letter to member and draft provider letters for director's signature; entry of appeals into appropriate database; and processing of internal quality of care referrals.

• Complete, organize and oversee the appeal process of the unit to ensure all telephone and written appeals are processed accurately and promptly.
• Coordinate all appeal functions which involves preparing summary reports; categorizing and routing medical appeals to the appropriate departments for action, and acting as the liaison with other units regarding appeal issues.
• Accurately respond by telephone, in person, or through correspondence to all inquiries involving requests for appeals
• Determine need for obtaining additional information and notifying members and/or providers as related to the processing of appeals.
• Respond to appeal requests within designated time requirements.
• Acknowledge member complaints within the regulatory timeframe.
• Compose letter to provider for management approval, track timeliness of response, and send follow-up letters as appropriate.
• Coordinate internal quality of care referral.
• Promote goodwill of our customer population through capable, efficient, caring, and composed performance.
• Coordinate and maintain system of tracking member complaints and appeals which includes identification and resolution of member concerns or outcome of appeal or internal quality of care referral.
• Provider support to supervisor, and appeals RN, and grievance coordinator as necessary.
• Identify trends and communicate this information to the supervisor.
• Communicate and interact effectively and professionally with co-workers, management, customers, etc.
• Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
• Maintain complete confidentiality of company business.
• Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.

Required Skills and Experience:

• 2 years experience researching and responding to telephone and / or correspondence inquiries regarding health insurance claims/services OR 1 year health insurance plus 2 years of customer service experience.
• Effective analytical, problem solving and research skills.
• Effective organizational skills to accommodate large volume of reference materials combined with time management skills to achieve accessibility to callers.
• Effective verbal and written communication skills to include the ability to clearly express oneself in a well-modulated tone with correct grammar and attention to enunciation.

Preferred Skills and Experience:

• Medical terminology.
• Knowledge of appeals processing.
• Ability to think clearly and maintain a professional, poised attitude under pressure.
• Detail oriented.

Seniority level

• Seniority level

  Associate

Employment type

• Employment type

  Contract

Job function

• Job function

  Customer Service, Administrative, and Health Care Provider

• Industries

  Medical Practices, Hospitals and Health Care, and Public Health

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Inferred from the description for this job

Medical insurance

Vision insurance

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