Senior Appeals Coordinator - Healthcare Claims & Compliance

Judi Health; Charlotte (NC); Hybrid; CAD 90,030,000 - 112,419,000; Full time

Benefits offered by this job

Hybrid work model

Job summary

Judi Health seeks a Senior Coordinator, Appeals to monitor, handle and escalate appeals, supporting multiple parties of our TPA team. You will assist with daily operations of our TPA, including appeals, root cause analysis, IDR and more.

This role offers the opportunity to influence best practices and join a team redefining healthcare operations excellence. Join Judi Health’s TPA team in a hybrid setup, collaborating with product and stakeholder teams to drive efficiency.

Qualifications

• 3+ years of TPA / health plan experience in Claims Adjudication, Appeals, or other applicable department needs.
• Advanced knowledge of appeals workflows, including documentation requirements for Providers and Administrators.
• Ability to interpret multiple client plan designs and SPDs.
• Familiarity with NSA regulations and the IDR Process.
• Advanced knowledge of CPT, HCPCs, ICD-10, CDT coding a plus.
• Self-funded plans, Medicare/Government programs and ERISA experience preferred.
• Attention to detail with ability to shift priorities in a fast-paced environment.
• Exceptional written and verbal communication skills.

Responsibilities

• Drives cross-functional collaboration with product/dev and other stakeholder teams to improve Judi operations.
• 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 records of processed appeals.
• Suggest process improvements to enhance daily operations for efficiency and quality.
• Identify and escalate operational and systemic discrepancies to avoid care disruption.
• Develops policies, training materials, and delivers education for cross-functional teams.
• Maintain quality levels and SLA response times.
• Support general business or team needs as assigned.
• Ensure adherence to Judi Health Code of Conduct and reporting of noncompliance.

Skills

TPA experience

Claims adjudication

Appeals workflows

IDR process

Plan designs

NSA regulations

CPT/HCPCS/ICD-10

ERISA experience

Communication

Attention to detail

Education

Bachelor’s degree

Job description

Judi Health seeks a Senior Coordinator, Appeals to monitor, handle and escalate appeals, supporting multiple parties of our TPA team. You will assist with daily operations of our TPA, including appeals, root cause analysis, IDR and more.

This role offers the opportunity to influence best practices and join a team redefining healthcare operations excellence. Join Judi Health’s TPA team in a hybrid setup, collaborating with product and stakeholder teams to drive efficiency.