Career Center

Job SummaryProvides guidance and mentoring to individual Appeals Coordinators including training, workload distribution, tracking and analysis of performance metrics. Identifies and develops best practices across the department. Assists with regulator site visits and directs and provides leadership on activities conducted by the Appeals and Grievances staff. Serves as a liaison between Members and the Plan with appeals regarding denied claims/services, referrals, membership and benefit issues and concerns regarding quality of care or service.Job DutiesServes as a lead for other team members or internal customers for Appeals and Grievances.Tracks all cases in appeal specifically for performance measurements and outcomes while ensuring case volume is ap