Join careerzynith, a leading healthcare organization, and make a meaningful difference in the lives of our customers. As a highly skilled and customer-focused Coordinator, Complaint & Appeals, you'll play a vital role in ensuring timely and customer-centric responses to complaint and appeal scenarios. This dynamic role offers the flexibility to work from our remote office and home, providing a perfect blend of work-life balance and career growth opportunities. At careerzynith, we're committed to delivering enhanced human-centric healthcare for a rapidly changing world. Our purpose guides our commitment to making a positive impact, and we're seeking individuals who share our passion and want to drive positive change in healthcare.

About careerzynith

careerzynith is a healthcare organization dedicated to providing exceptional customer experiences and driving positive change in the industry. We believe in bringing our heart to every moment of our customers' health, and our purpose guides our commitment to delivering enhanced human-centric healthcare. With a focus on innovation, collaboration, and customer-centricity, we're shaping the future of healthcare and making a meaningful difference in the lives of our customers.

Position Summary

As a Coordinator, Complaint & Appeals, you'll be responsible for managing complaint and appeal scenarios for all products, ensuring timely and customer-focused responses. You'll identify trends and emerging issues, reporting and recommending solutions to drive continuous improvement. This role requires a high level of attention to detail, excellent communication skills, and a customer-centric approach.

Key Responsibilities:

* Review and process appeals filed by participating providers

• Assist with adherence to regulatory requirements, conduct internal audits, and address compliance issues
• Draft and send appeal decision letters
• Identify trends and emerging issues, reporting and recommending solutions to drive continuous improvement
• Collaborate with cross-functional teams to resolve complex issues and improve processes
• Develop and maintain knowledge of regulatory requirements, industry trends, and best practices

Requirements:

* 1 year of experience in HMO and Traditional claim platforms, products, and benefits, patient management, product, compliance and regulatory analysis, special investigations, provider relations, customer service, or audit experience

• High School or Equivalent education
• Strong analytical and problem-solving skills
• Excellent communication and interpersonal skills
• Ability to work in a fast-paced environment and prioritize multiple tasks and deadlines

Preferred Qualifications:

* Medicare experience

• Claims experience
• Experience in reading or researching benefit language in Summary Plan Description (SPDs) or Certificate of Coverage (COCs)
• Experience in research and analysis of claim processing
• Knowledge of regulatory requirements, industry trends, and best practices

What We Offer:

* Competitive salary: $17.00 - $28.46 per hour

• Comprehensive benefits package, including medical, dental, and vision benefits
• 401(k) retirement savings plan and Employee Stock Purchase Plan
• Fully-paid term life insurance plan and short-term and long-term disability benefits
• Paid Time Off (PTO) and paid holidays
• Opportunities for education assistance, free development courses, and careerzynith store discounts
• Collaborative and dynamic work environment with a focus on innovation and customer-centricity
• Career growth opportunities and professional development

Work Environment and Company Culture:

careerzynith is committed to creating a work environment that is inclusive, diverse, and supportive. We believe in fostering a culture of collaboration, innovation, and customer-centricity, and we're seeking individuals who share our values and passion for making a positive impact in healthcare. Our remote office and home work arrangement offers the flexibility to work in a comfortable and productive environment, while our comprehensive benefits package and career growth opportunities provide a sense of security and stability.

How to Apply:

If you're passionate about delivering exceptional customer experiences and driving positive change in healthcare, we want to hear from you! Apply now and join our team of dedicated professionals who are shaping the future of healthcare. Apply for this job