Grievance and Appeal Specialist

A company is looking for a Grievance and Appeal Specialist.

Key Responsibilities

Conduct thorough investigations of grievances, complaints, and appeals, documenting findings

Ensure compliance with CMS reporting and data validation requirements while maintaining accurate case documentation

Participate in process improvement initiatives and assist in developing training materials and procedures

Required Qualifications

High School Diploma or GED

Minimum of 2 years of experience in appeals and grievance or a related field

Knowledge of plan products, processes, and enrollment rules

Ability to communicate operational requirements effectively

Familiarity with HIPAA and data security guidelines