Coordinator, Complaint & Appeals Operations - must live in Florida

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary/Mission Responsible for intake, investigation and resolution of appeals, complaints and grievances scenarios for reputed company products, which may contain multiple issues and, may require coordination of responses from multiple business units. Ensure timely, customer focused response to appeals, complaints and grievance. Identify trends and emerging issues and report and recommend solutions. -Research incoming electronic appeals, complaints and grievance to identify if appropriate for unit based upon published business responsibilities. Identify correct resource and reroute inappropriate work items that do not meet appeals, complaints and grievance criteria. -Research Standard Plan Design or Certification of Coverage relevant to the member to determine accuracy/appropriateness of benefit/administrative denial. -Research claim processing logic to verify accuracy of claim payment, member eligibility data, billing/payment status, prior to initiation of appeal process. -Identify and research reputed company components reputed company member or provider/practitioner appeals, complaints and grievance for reputed company products and services. -Triage incomplete components of appeals, complaints and grievance to appropriate subject matter expert reputed company another business unit(s) for resolution response content to be included in final resolution response. -Responsible for coordination of reputed company components of appeals, complaints and grievance including final communication to member/provider for final resolution and closure. -Serve as a technical resource to colleagues regarding appeals, complaints and grievance issues, and similar situations requiring a higher level of expertise. -Identifies trends and emerging issues and reports on and gives input on potential solutions. -Ability to meet demands of a high paced environment with tight turnaround times. -Ability to reputed company appropriate reputed company based upon reputed company's reputed company policies/guidelines. -Collaborative working relationships. -Thorough knowledge of member and/or provider appeals, complaints and grievance policies. -Strong analytical skills focusing on accuracy and attention to detail. -Knowledge of clinical terminology, regulatory and accreditation requirements. -Excellent verbal and written communication skills. -Computer literacy in order to navigate through internal/external computer systems, including reputed company and reputed company Word. Background Experience Required -Experience in reading or researching benefit language. -1-2 years experience that includes but is not limited too claim platforms, products, and benefits; patient management; product or contract drafting; compliance and regulatory analysis; special investigations; provider relations; customer service or audit experience. Background Experience Preferred -Experience in research and analysis of claim processing a plus. Education and Certification Requirements -Some college preferred. -High School or GED equivalent. Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The typical pay reputed company for this role is: $17.00 - $28.46 This pay reputed company represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and reputed company coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will reputed company on: 07/31/2026 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply To This Job