Appeals Coordinator, Geisinger Health Plan (Pennsylvania resident)

Provides administration of the Appeals and Grievance process for members, serving as a liaison between Members and the Plan with appeals regarding denied claims/services, referrals, membership and benefit issues and concerns regarding quality of care or service. Prepares and facilitates Member appeals, communicates with Members, Representatives, Vendors and Medical Providers to obtain necessary information, investigates details with health care providers, legal services, internal medical staff and administration, and ensures timely documentation and adherence to timelines set by DOL/DOI/DOI/NCQA/CMS. Maintains databases for reporting/tracking, conducts audits for accuracy, coordinates review committees and educational sessions with other Health Plan departments, stays compliant with applicable laws/regulations, and suggests policy improvements. Travel may be required; work is typically performed in an office environment. Education/Experience: High School Diploma or Equivalent (GED) and minimum 5 years relevant experience. Our values emphasize care, excellence, learning, innovation, and safety; the role supports regulatory and accreditation standards across lines of business.