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Appeals and Grievances SpecialistVirtualVocations • Fresno, California, United States
Appeals and Grievances Specialist

Appeals and Grievances Specialist

VirtualVocations • Fresno, California, United States
28 days ago
Job type
  • Full-time
Job description
Providing comprehensive support for claims activities, the full-time Appeals and Grievances Specialist will manage the resolution of member and provider complaints, ensuring compliance with CMS standards while working remotely. Key responsibilities Facilitates research and resolution of appeals, disputes, grievances, and complaints from members and providers Requests and reviews medical records and detailed bills to determine appropriate outcomes for appeals and grievances Prepares appeal summaries and correspondence, documenting findings and trends in accordance with regulatory requirements Required qualifications At least 2 years of managed care experience in a call center, appeals, and/or claims environment Health claims processing experience, including coordination of benefits and eligibility criteria Experience with Medicaid and Medicare claims denials and appeals processing Strong organizational and time management skills Proficiency in Microsoft Office suite or applicable software programs
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Appeals and Grievances Specialist • Fresno, California, United States

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