Appeals and Grievances Specialist

A company is looking for an Appeals & Grievances Specialist, working remotely in the Pacific Time Zone.

Key Responsibilities

Facilitates research and resolution of appeals, grievances, and complaints from members and providers

Researches claims appeals and grievances to determine appropriate outcomes and prepares necessary documentation

Contacts members and providers as needed and ensures compliance with regulatory timelines and guidelines

Required Qualifications

At least 2 years of managed care experience in a call center, appeals, 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 and applicable software programs