MagnaCare is seeking experienced Appeals Coordinators to investigate and resolve grievances, provider payment disputes, and medical appeals submitted by members and providers. This role requires strong analytical skills, attention to detail, and a commitment to compliance with all regulatory requirements. This position is hybrid and may require work on-site in the office on a consistent basis.
Primary Responsibilities
Investigate and resolve grievances, provider payment disputes, and any other non-medical appeals submitted by members and providers, ensuring compliance with established regulations in all determination responses.
Process complex claims, including professional, facility, and ancillary.
Provide timely and accurate responses to appeals, grievances, and other correspondence.
Communicate effectively with individuals and teams to ensure prompt, high-quality handling of customer requests.
Research and document relevant information for claims requiring adjudication.
Apply medical policies, contractual provisions, and operational procedures for accurate adjudication and determination responses.
Support Customer Service in addressing customer inquiries related to correspondence.
Demonstrate adaptability and willingness to provide backup support across various departments and roles as needed.
Essential Qualifications
Minimum 1 year of experience in medical billing, claims adjudication, or appeals and grievances handling.
Prior experience handling appeals for Labor unions is preferred.
Strong knowledge of contracts, medical terminology, claims processing, and regulatory compliance related to appeals.
Excellent written and verbal communication skills, with the ability to negotiate and resolve complex issues.
Strong analytical and problem-solving skills, with attention to detail and accuracy.
Ability to meet expected production and quality standards in a fast-paced environment.
Proficiency in Microsoft Office (Word and Excel).
Professional demeanor, with the ability to work effectively under pressure and manage multiple priorities.
At MagnaCare LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect, and increasing diversity, inclusion, and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all your unique abilities.
For more than 30 years, MagnaCare LLC has been a trusted partner in delivering flexible, customized solutions for self-insured organizations. As a national third-party administrator (TPA), we combine proprietary technology, network expertise, and a deep understanding of labor to help our clients achieve their goals while supporting the people they serve.
Our focus on labor means we work closely with funds, Taft-Hartley Trusts, and other self-insured groups to deliver tailored solutions that go beyond the basics. From health plan administration and eligibility management to contribution accounting, we provide the tools and support organizations need to succeed. With specialized offerings such as flexible network administration, direct contracting, in-house medical and care management, and workers’ compensation programs, we create benefit plans that address unique needs with precision.
