Appeals and Grievances Coordinator

Avēsis

Primary contact for members, providers, and clients in the appeals and grievances process at Avesis. Timely resolution of dental and vision A&G cases within a regulated managed care environment.

Posted 6/26/2026full-timeRemote • 🇺🇸 United StatesJunior💰 $18,330 - $30,550 per yearWebsite

About the role

Key responsibilities & impact

The Appeals and Grievances Coordinator is the primary point of contact for members, providers, and clients throughout the appeals and grievances process.
Provide timely, accurate, and compliant resolution of dental and vision A&G cases within a regulated managed care environment.
Responsible for the completion of appeals and grievances from all states.
Perform reviews of member and provider appeals and grievances for dental and vision waiver services.
Analyze medical records, supporting documentation, and applicable guidelines to make informed decisions.
Document rationale clearly and accurately in alignment with organizational and regulatory standards.
Work closely with clinical teams as well as other internal operational areas to resolve complex cases.
Communicate outcomes effectively to members and providers.
Review and complete all provider appeals and grievances within required timeframes.
Review and complete member appeals and grievances within required timeframes.
Apply Avesis policy, plan documents and/or state guidelines when processing appeals or grievances.
Issue administrative denials appropriately.
Refer denials based on medical necessity to appropriate clinical staff.
Collaborate with appropriate stakeholders to prepare all requests for Independent External Review when required.
Participate in training programs to maintain functional expertise.
Draft formal correspondence such as acknowledgement and resolution notices.

Requirements

What you’ll need

High school diploma or equivalent.
1+ years of exposure with medical, dental or vision terminology and/or coding (ICD-10, CDT, CPT).
1+ years of experience with case management platforms or healthcare administrative systems
Working knowledge of medical, dental, or vision terminology and coding (ICD-10, CDT, CPT) relevant to the line of business.
Proficiency in Microsoft Office Suite and experience with case management platforms or healthcare administrative systems.
Ability to draft formal correspondence.
Demonstrated understanding of HIPAA and the ability to handle protected health information in a compliant manner.
Proven ability to manage a high-volume caseload, prioritize competing deadlines, and meet strict regulatory turnaround time requirements.
Strong attention to detail, critical thinking, and sound judgment with the ability to work both independently and collaboratively across departments.
Flexible to work alternating Saturday during holiday shifts as required.

Benefits

Comp & perks

Excellent medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period.
Life and disability insurance.
A great 401(k) with company match.
Tuition assistance, paid parental leave and backup family care.
Dynamic, modern work environments that promote collaboration and creativity to develop and empower talent.
Flexible time off, dress code, and work location policies to balance your work and life in the ways that suit you best.
Employee Resource Groups that advocate for inclusion and diversity in all that we do.
Social responsibility in all aspects of our work.

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

ICD-10CDTCPTcase managementmedical terminologydental terminologyvision terminologydocumentationregulatory compliancecritical thinking

Soft Skills

attention to detailcommunicationcollaborationtime managementindependent workjudgmentprioritizationflexibilityproblem-solvingtraining participation