Medicare and Medicaid Complaint Coordinator - Hybrid Alpharetta

The Medicare and Medicaid Complaint Coordinator is responsible for managing and responding to complaints initiated by Medicare Advantage Organizations (MAOs) and Medicaid carriers, ensuring a streamlined and timely resolution process. This role involves direct communication with MAOs, internal business partners, and providers, as well as participation in meetings with plans, Account Managers, and cross-functional teams to address concerns effectively.

Please note this position is hybrid and requires the employee to report to the Alpharetta office as needed for meaningful in-person events such as town halls, team building, training, volunteering, etc.

Responsibilities:

• Log, track, and manage inquiries, appeals, and grievances from MAOs and Medicaid carriers.
• Investigate complaints by collaborating with MAO plans, providers, and internal departments, ensuring thorough information gathering and resolution.
• Conduct research to identify relevant policies, including plan provisions, Evidence of Coverage (EOC), and regulatory guidelines applicable to appeals and grievances.
• Request, obtain, and document detailed invoices as necessary to support research and case resolution.
• Summarize case details and compile necessary clinical documentation for review by the Clinical Review department, working closely with Dental Consultants and clinical staff to address medical or dental-related concerns.
• Ensure all appeals comply with State, Federal, and Delta Dental quality guidelines, meeting required timelines and resolution standards.
• Assist in coordinating interdepartmental issue resolution efficiently and effectively.

• Ability to work a starting schedule of 8 a.m. to 4:45 p.m. eastern, Monday through Friday. Alternative schedule options may be considered after the training/nesting period based on performance.
• Experience in customer service, provider services, healthcare, or dental managed care, handling complex or escalated issues in government and commercial insurance.
• 3 or more years' experience researching and resolving inquiries from State and Federal agencies regarding Medicare and Medicaid complaints.
• Strong problem-solving and critical-thinking skills, with the ability to analyze cases, identify solutions, and drive them to resolution.
• Excellent organizational and time management abilities, with keen attention to detail.
• Basic proficiency in Microsoft Office.
• Strong verbal and written communication skills, with the ability to engage and collaborate with diverse stakeholders.
• Excellent ability to thrive in a fast-paced, high-production environment.

• Competitive base and incentive pay
• 401(k) with robust matching and non-matching contributions
• Rich medical & pharmacy benefits
• 100% employer-paid dental and vision benefits
• Holistic wellbeing program with deep financial incentives
• Generous paid time off plus 12 paid holidays and your birthday off
• Culture of growth and learning: career development; tuition reimbursement; recognition program
• Family support: adoption assistance, fertility treatment, child, elder & pet care assistance
• Social responsibility and volunteer opportunities
• Employee discount program