Appeals Operations Coordinator – Healthcare Benefits

Judi Health, LLC; Charlotte, Northern (NC, KY); Hybrid; USD 32,000 - 39,000; Full time

Job summary

Judi Health in Charlotte, NC is seeking a Senior Coordinator, Appeals to join the TPA team. The role focuses on monitoring, handling, and escalating appeals, with support across the TPA workflow, including IDR and root cause analyses.

You will influence operational best practices and help deliver efficient, compliant client service. The position requires 3+ years in TPA/health plan activities, strong communication, and attention to detail in a fast-paced environment.

Qualifications

• 3+ years of TPA/health plan experience in Claims Adjudication, Appeals, or other applicable department needs.
• Advanced knowledge of appeals workflows and documentation requirements for Providers and Administrators.
• Ability to interpret multiple client plan designs and SPDs.
• Familiarity with NSA regulations and the IDR Process.

Responsibilities

• Drives cross-functional collaboration with product/dev and stakeholder teams to improve Judi drive operational efficiency and client needs.
• Investigate and resolve disputes regarding coverage, medical claims, and service grievances including NSA and IDR.
• Monitor appeal deadlines and ensure communications comply with regulatory guidelines.
• Log case information, upload documentation, and maintain detailed records of all processed appeals.
• Make recommendations to streamline processes for efficiency and quality outcomes.
• Identify and troubleshoot operational/discrepancies to avoid care disruption.
• Develops standard policy, procedures, and training materials for cross-functional teams.

Skills

TPA experience

Claims adjudication

Regulatory knowledge

Communication skills

Job description

Judi Health in Charlotte, NC is seeking a Senior Coordinator, Appeals to join the TPA team. The role focuses on monitoring, handling, and escalating appeals, with support across the TPA workflow, including IDR and root cause analyses.

You will influence operational best practices and help deliver efficient, compliant client service. The position requires 3+ years in TPA/health plan activities, strong communication, and attention to detail in a fast-paced environment.