Full-time Senior Coordinator (remote) handling appeals, complaints, and grievance cases: investigates complex escalations, ensures timely and compliant responses, identifies trends, produces reports, and serves as point of contact for leadership/regulators. Requires at least 2 years' related experience (claims, benefits, patient management, compliance, provider relations, customer service or audits). Pay range: $18.50–$31.72/hour.

Responsible for reviewing and adjudicating complex and sensitive medical claims per plan guidelines, applying medical necessity rules, verifying eligibility, identifying payment discrepancies, and performing claim rework calculations. Acts as a subject matter expert by coaching and mentoring team members, handling escalations, and conducting outbound calls to obtain required information. Requires a minimum of 18 months of medical claim processing experience with a health insurance payor or third-party administrator.