New Mexico Appeals Coordinator

Job Summary

A company is looking for an Appeals and Grievance Coordinator.

Key Responsibilities

• Coordinate daily activities of the Appeals & Grievance Department, providing mentorship and oversight
• Investigate and resolve customer complaints and appeals/grievances, making decisions in disputed cases
• Maintain compliance with regulatory standards and represent the organization in audits and meetings with regulatory bodies

Required Qualifications

• High School Diploma or GED
• Five years of customer service experience required
• Three years of experience in a healthcare or insurance setting, with one year in complaint, grievance, or appeal processing
• Bachelor's degree preferred in a healthcare-related field
• Preferred experience in claims processing and patient financial services in an HMO/MCO/MSO or health insurance environment