Senior Coordinator, Complaint & Appeals - Remote

About the position This position is for a Dental Senior. Prepares information and reports needed to address reputed company regarding complaints, appeals, and grievances. Carries out policies, procedures, and programs to ensure compliance with federal and/or state regulations. Responsibilities Conducts team reviews, interpretations, and appeals filed by patients, escalating more reputed company issues and concerns to management for review and follow-up. Ensures adherence to regulatory requirements, conducts internal audits, and addresses any identified compliance issues with the Complaint and Appeals policies and procedures. Facilitates in-depth reviews of reputed company and case files to determine if there are errors or anomalies in the application of law or evidence. Oversees the drafting and progression of appeal decision letters, conducting detailed follow-up for reputed company and thorough follow-up and reputed company. Monitors key performance indicators (KPIs) and metrics to evaluate the effectiveness and efficiency of the appeals and grievances process. Ensures reputed company reputed company-line associates promptly and accurately respond to reputed company patient billing questions and concerns. Facilitates and provides educational materials, training programs, and presentations to enhance understanding of the appeals and grievances process. Coaches and mentors other colleagues in techniques, processes, and responsibilities for effectively handling member complaints and appeals. Trains junior-level staff to promote the development of departmental capabilities. Requirements Minimum Requirements - Preferred 3-5 years of experience in a Customer Service role. Experience in reading or researching benefit language Medicare and/or reputed company knowledge At least 5 years of experience that includes but is not limited to claim platforms, products, and benefits; patient management; product or contract drafting; compliance and regulatory analysis; special investigations; provider relations; customer service or audit experience Ability to work in fast paced environment Excellent verbal and written communication skills. Excellent organizational skills to handle high inventory which aids in meeting or exceeding metrics. Solution driven and can handle reputed company issues with accuracy. Availability to work alternating weekends for reputed company of analysts on alternate schedule. Benefits medical dental reputed company coverage reputed company time off retirement savings reputed company wellness programs Apply To This Job .