Appeals Coordinator in United States at Jobgether

This position is posted by Jobgether on behalf of a partner company. We are currently looking for an Appeals Coordinator in the United States.

As an Appeals Coordinator, you will play a vital role in ensuring the accurate review, tracking, and resolution of medical claims appeals within a fast-paced healthcare environment. This position offers the opportunity to work closely with internal teams and external partners to support fair and timely appeal outcomes while maintaining high standards of accuracy and compliance. You will leverage your knowledge of medical claims processing to evaluate appeal documentation, manage case workflows, and communicate effectively with stakeholders. Ideal for detail-oriented professionals, this role combines analytical problem-solving with customer-focused service. Working remotely, you will contribute directly to operational excellence and help deliver positive experiences for members and partners alike.

• Monitor, log, and track all incoming appeals to ensure accurate and timely processing.
• Review appeal requests and supporting documentation to assess completeness and appropriateness.
• Analyze Summary Plan Documents and claim information to determine the validity of appeals.
• Prepare and compose appeal responses when required, ensuring clarity and compliance with established guidelines.
• Coordinate with internal departments and external business partners to facilitate appeal reviews and resolutions.
• Maintain accurate records by documenting appeal statuses, outcomes, and related activities within designated systems and databases.
• Follow up on pending and aging appeals to ensure timely resolution and communication.
• Prioritize incoming referrals and manage multiple tasks effectively to meet deadlines and service expectations.
• Perform additional duties and support activities as assigned.

• Bachelor’s degree or equivalent combination of education and relevant professional experience.
• Minimum of 2 years of experience handling medical claims appeals in a healthcare, insurance, or benefits administration environment.
• Strong understanding of medical claims processing and appeals procedures.
• Proficiency with Microsoft Office Suite and the ability to quickly learn new systems and technologies.
• Excellent analytical and problem-solving abilities with a strong attention to detail.
• Strong written and verbal communication skills, including the ability to communicate effectively with various stakeholders.
• Exceptional organizational and time-management skills with the ability to prioritize competing responsibilities.
• Demonstrated commitment to accountability, quality, customer service, and continuous improvement.
• Ability to work independently in a remote environment while maintaining productivity and collaboration.

• Competitive hourly compensation ranging from $20.00 to $21.00 per hour.
• Fully remote work environment with flexibility and work-from-home convenience.
• Comprehensive medical, dental, and vision insurance coverage.
• Life and disability insurance benefits.
• Generous paid time off program.
• Tuition reimbursement opportunities to support professional development.
• Employee Assistance Program (EAP).
• Technology stipend to support remote work needs.
• Access to a competitive Total Rewards package designed to support employee well-being and career growth.