Quality Assurance Appeals Coordinator

Job Title: Quality Assurance Appeals Coordinator

FLSA Status: Non-Exempt – Hourly

Compensation Expectations: $28.00 - $30.00 DOE

Role Location: Remote

Marpai Administrators (Subsidiary of Marpai Inc. (NASDAQ: MRAI)) is a technology company transforming the Third Party Administration sector serving employers with self-funded health plans. Marpai Administrators (“Marpai”) is an AI-powered national TPA (third party administrator) using deep learning and machine learning to maximize population health outcomes with the greatest cost efficiency for any health plan budget. We create healthier members and a healthier bottom line. Marpai proactively targets at-risk members with meaningful clinical interventions to improve outcomes.

ABOUT THE POSITION:

This role reports to the Claims Manager and completes audit and quality reviews of enrollment and claim transactions. The Appeals Coordinator is responsible for coordinating, processing, and tracking all member and provider appeals and grievances. This role involves ensuring that all cases are handled fairly, promptly, and in strict compliance with all applicable state and federal laws and regulatory guidelines (e.g., HIPAA, CMS, NCQA). The coordinator serves as the primary liaison between members, providers, and the organization to facilitate resolution.

It is vital that the coordinator be knowledgeable about the health care industry and regulations affecting the industry. Detailed oriented problem-solving skills are essential.

WHAT YOU WILL BE DOING:

The Quality Assurance Appeals Coordinator day to day responsibilities:

• Case management: Receive, prioritize, and process incoming written and verbal appeal requests.
• Investigation and Analysis: Conduct thorough investigations by gather and analyzing all necessary documentation, including medical records, claim details, and denial letters to under the full scope of the case.
• Documentation: Accurately document all communications and case information in the appeals tracking database and case files, ensuring meticulous record-keeping.
• Communication: Draft and prepare accurate, professional response letters and other client-facing communications to inform all involved parties of the appeal status and resolution.
• Compliance: Ensure all appeal activities and correspondence meet established internal policies and external regulatory timeframes and standards.
• Coordination: Collaborate with various internal departments to gather information, coordinate case reviews and ensure comprehensive support of each appeal
• Trend Reporting: Monitor appeal treads, identify root causes of denials and report findings to management to support process improvement initiatives.
  
  

What Success Looks Like

• Ability to handle confidential & sensitive information.
• Excellent verbal and written communication skills as well as exemplary organizational skills
• Computer expertise in MS Word, Excel, PowerPoint, & Outlook at the intermediate level
• Ability to multi-task
• Strong attention to detail
• Ability to understand and apply on-line documentation policies and procedures. Ability to handle large volumes of work, solve problems and manage multiple assignments while meeting critical deadlines
  
  

What Do You Need

• High proficiency in MS Office Suite of products
• 2 years of experience in health insurance industry (preferably in claims and audit)
• Preferred 2 years claims processing, but not required
• Work independently
  
  

WORK REQUIREMENTS:

• Fast paced, dynamic work environment requiring the ability to be adaptive, innovative and flexible
• Travel minimal
  
  

WHY WORK AT MARPAI?

• Generous PTO
• Medical and Prescription
• EAP
• FSA / HSA / Dependent Care
• Dental
• Vision
• Life and Disability
• STD/LTD
• Voluntary Benefits: Critical Illness, Accident, Hospital
• 401k with Employer Match
• LegalShield
• Identity Theft Protection
  
  

Marpai is an equal opportunity workplace. We are committed to equal opportunity regardless of race, color, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, or veteran status.

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