Remote Member Appeals & Grievances Coordinator

WellSense Health Plan; United States; Remote; USD 28,000 - 39,000; Full time

Benefits offered by this job

Full-time remote work

Competitive salaries

Excellent benefits

Job summary

WellSense Health Plan is seeking an A&G Coordinator to support member appeals and grievances with administrative accuracy. This full-time role is remote and focuses on intake, data entry, and timely communication with departments and members.

Responsibilities include ensuring precise record-keeping, compiling reports, and assisting management with audits and trend analysis. Ideal candidates have healthcare experience and CPC certification is a plus.

Qualifications

• Bachelor's degree in Health Care Administration or related field.
• Proficient with Microsoft Office applications.
• Experience using proprietary healthcare management systems.
• Certified Professional Coder (CPC) certification is preferred.
• 2+ years in a healthcare setting related to Appeals and Grievances.

Responsibilities

• Identify and input appeals and grievances during intake and route to specialists.
• Ensure accurate data entry in the system of record for trend analysis.
• Identify trends to raise to A&G Management.
• Assist with audits and reporting as needed.
• Prepare daily/weekly/monthly reports for management.
• Participate in training and maintain updated materials.

Skills

Attention to detail

Organizational skills

Communication skills

Independent work

Customer service

Data analysis

Multitasking

Education

Bachelor's degree in Health Care Administration

Tools

JIVA

Facets

Express Scripts

HPMS

Access

Job description

WellSense Health Plan is seeking an A&G Coordinator to support member appeals and grievances with administrative accuracy. This full-time role is remote and focuses on intake, data entry, and timely communication with departments and members.

Responsibilities include ensuring precise record-keeping, compiling reports, and assisting management with audits and trend analysis. Ideal candidates have healthcare experience and CPC certification is a plus.