Quality Resolution Coordinator

Company Overview

Detego Health's mission is to connect real-life needs with innovative product design, delivering affordable, approachable health care benefits that feel personal, while deeply understanding our members and partners to improve lives and redefine access to health care.

We're looking for passionate people who want to make a difference and help us redefine access to health care for individuals and small businesses by delivering certainty, connection and significance where others won’t.

Ready to build something great together? Join a team that values growth, collaboration and the unique perspective you bring.

Position Summary

The Quality Resolution Coordinator provides centralized coordination, tracking, and quality assurance for escalated complaints, grievances, regulatory inquiries, and high-risk member issues. The role supports Department of Insurance (DOI), Better Business Bureau (BBB), regulatory, and executive matters by ensuring each case is logged accurately, routed to the correct owner, supported by complete documentation, monitored against required deadlines, and closed with defensible evidence.

This position coordinates work across accountable business functions without replacing functional ownership, legal review, clinical judgment, claims adjudication, payment authority, or executive decision rights.

Key Responsibilities

Complaint and Regulatory Intake

• Serve as the central coordination point for assigned DOI, BBB, regulatory, executive, and other high-visibility complaints and escalations.

• Log and classify matters in the approved tracking system, including receipt date, due date, priority, owner, status, dependencies, evidence location, and escalation needs.

• Route each matter to the appropriate accountable function, such as Claims, Appeals, Payment Integrity, Legal, Clinical, Operations, Finance, Member Services, or System Administration.

• Maintain a complete case checklist and confirm required acknowledgements, internal milestones, and external deadlines.

Investigation Coordination and Information Gathering

• Coordinate cross-functional fact gathering and follow-up without independently determining legal, clinical, benefit, or claims outcomes.

• Request and organize supporting records, including claims histories, EOBs, call logs, plan documents, correspondence, payment information, and other relevant evidence.

• Validate documentation for completeness, consistency, appropriate handling of confidential information, and readiness for review.

• Prepare concise case summaries and structured investigation packets for leadership, Legal, Compliance, or other designated reviewers.

Deadline, Escalation, and Work Visibility

• Track statutory deadlines, internal service-level expectations, review milestones, approvals, and final submission or response status.

• Prepare weekly views of open matters, aging items, approaching deadlines, blocked dependencies, and reassignment or decision needs.

• Escalate overdue inputs, unclear ownership, sensitive information, deadline risk, and unresolved dependencies before service or regulatory exposure occurs.

• Maintain clear follow-up records, decision logs, and objective closure evidence.

Quality Assurance and Case Closure

• Perform pre-close quality checks to confirm documentation completeness, accuracy, version control, approval status, response evidence, and retrievability.

• Confirm required notifications and system updates are completed before a matter is marked closed.

• Distinguish case closure from remaining operational, payment, corrective-action, or member follow-up obligations and keep unresolved actions visible.

• Apply approved naming, confidentiality, retention, and evidence-location standards to coordinated case records.

Reporting and Continuous Improvement

• Support reporting on complaint volume, aging, response status, deadline exposure, root causes, dependencies, and closure trends.

• Identify recurring complaint drivers, documentation gaps, control failures, and workflow friction for leadership review.

• Partner with accountable teams to track approved corrective actions and process improvements.

• Maintain procedures, checklists, templates, contact maps, and cross-training materials needed for consistent complaint coordination and coverage.

Qualifications

• Three to five years of experience in complaint coordination, grievance management, issue resolution, compliance support, healthcare operations, claims operations, or another regulated environment.

• Demonstrated ability to coordinate cross-functional investigations and manage multiple deadline-driven matters concurrently.

• Strong written communication, documentation, organization, and follow-through skills.

• Ability to handle sensitive information professionally and maintain accurate, audit-ready records.

• Proficiency with Microsoft 365 and experience using tracking, document-management, workflow, or case-management tools.

• Healthcare payer, third-party administrator, benefits administration, claims, or member-services experience.

• Experience supporting DOI, BBB, regulatory, executive, or high-risk complaint matters.

• Familiarity with EOBs, benefit interpretation, claims workflows, HIPAA concepts, and PHI handling.

• Experience with SharePoint, Power Automate, reporting tools, or comparable workflow systems.
  

Compensation & Benefits
Compensation: $29- $30

Work Location: Omaha-based employees will work in-office or on a hybrid schedule. We are also remote-friendly for employees located outside of the Omaha area.

Benefits: 401(k), 401(k) matching, Dental insurance, Employee assistance program, Health insurance, Health savings account, Life insurance, Paid time off, Vision insurance

Detego Health is an equal opportunity employer