Senior Coordinator, Appeals

Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels.

About the role

Join our Judi Health TPA team as a Senior Coordinator, Appeals, where you will play a pivotal role in monitoring, handling, and escalating appeals and provide support to multiple parties of our TPA team. You will help with daily operations of our TPA, including areas such as appeals, root cause analysis, IDR, and more. This position offers the opportunity to influence operational best practices and contribute to a team that is redefining operational excellence in the healthcare space. Hybrid schedule with 3 days in the Charlotte office.

Responsibilities

• Drive cross-functional collaboration with the product/dev team as well as additional stakeholder teams to ensure enhancements to Judi drive operational efficiency and support ongoing client needs
• Investigate and resolve client, patient, or provider disputes regarding coverage, medical claims, and service grievances including NSA and IDR
• Monitor appeal deadlines and ensure all communications and resolutions comply with regulatory guidelines
• Accurately log case information, upload documentation, and maintain detailed, up-to-date records of all processed appeals
• Make recommendations to streamline work processes and systems that support daily operations to create efficiency and quality outcomes
• Identify, troubleshoot, and escalate any operational and systemic discrepancies immediately to avoid care disruption
• Develop standard policy and procedures, training materials, and provide education for training and presentation to cross-functional teams
• Maintain acceptable and appropriate quality levels and production SLA response time
• Support general business or team needs, as assigned
• Adhere to the Judi Health Code of Conduct including reporting of noncompliance

Requirements

• Bachelor’s degree preferred
• 3+ years of TPA / health plan experience in Claims Adjudication, Appeals, or other applicable department needs
• Advanced knowledge of appeals workflows, including documentation requirements for Providers and Administrators
• Ability to interpret multiple client plan designs and SPDs
• Familiarity with NSA regulations and the IDR Process
• Advanced knowledge of CPT, HCPCs, ICD-10, CDT coding a plus
• Self-funded plans, Medicare/Government programs, and ERISA experience preferred
• Tremendous attention to detail, ability to shift priorities easily, and ability to work in a high-paced, deadline-driven environment
• Exceptional written and verbal communication skills

Pay

Salary Range: $22.69 USD - $28.37 USD per hour