Appeal and Grievance Coordinator - Prefer Candidate lives in VA

The Appeal and Grievance Coordinator is responsible for the intake, investigation, and resolution of appeals, complaints, and grievances for all products, which may involve multiple issues and require coordination across various business units. This role ensures timely, customer-focused responses and identifies trends and emerging issues, recommending solutions. Responsibilities include researching incoming appeals, complaints, and grievances to determine appropriate handling, rerouting inappropriate items, and verifying the accuracy of benefit denials, claim processing logic, member eligibility, and billing/payment status. The coordinator will also triage incomplete components to appropriate subject matter experts for resolution content and coordinate all components for final communication and closure. Additionally, this position serves as a technical resource to colleagues, identifies trends and emerging issues, and provides input on potential solutions. The role requires the ability to meet demands in a fast-paced environment with tight turnaround times and make appropriate decisions based on current policies and guidelines.