Member Appeals & Grievances Specialist (remote)

Member Appeals & Grievances Specialist (remote)

This is a remote position open to any qualified applicant that lives in the United States.

Summary :

We are seeking a dedicated Member Appeals & Grievance Specialist with a minimum of 2 years of experience to join our team. The ideal candidate will have strong technical skills in MS Excel, knowledge / navigation skills for Microsoft programs in fast paced, production driven environment and dedication to attendance adherence. Absences will not be permitted during training-approximately 6 weeks. This is a work-from-home position Monday - Friday with hours from 8 am - 4 : 30pm EST , and no travel is required.

Candidate will also have the desire to further their abilities and knowledge of Medicaid medical insurance processes as they will be responsible for the research and resolution of Medicaid provider appeals that will involve research of member benefits, eligibility, provider contracts, billing and coding, Utilization Management and state Medicaid policies.

Qualifications / Skills Needed :

Minimum of 2 years of Appeals and Grievance experience

Minimum of 2 years of medical claims processing experience (Must be with a healthcare plan, not on behalf of provider or provider's office)

At least 1 year of Medicaid insurance customer service or claims processing

Medicaid / Medicare Insurance Customer Service with managed care plans or directly with CMS

Billing and Coding-Medical Insurance

Knowledge of Member / Provider Appeals and Grievances, processes, resolutions, compliance TAT

Self-resolved troubleshooting ability for various IT issues

Knowledge of QNXT

Knowledge of PEGA

Knowledge of SharePoint

Sense of urgency with production and responsiveness to email and MS Teams

Ability to create and fax written communication in a professional manner including spelling and grammar.

Salary and Other Compensation :

Applications will be accepted until November 5, 2025.

The hourly rate for this position is between $17.00 - 18.00 per hour, depending on experience and other qualifications of the successful candidate.

This position is also eligible for Cognizant's discretionary annual incentive program, based on performance and subject to the terms of Cognizant's applicable plans.

Benefits : Cognizant offers the following benefits for this position, subject to applicable eligibility requirements : - Medical / Dental / Vision / Life Insurance - Paid holidays plus Paid Time Off - 401(k) plan and contributions - Long-term / Short-term Disability - Paid Parental Leave - Employee Stock Purchase Plan

Disclaimer : The hourly rate, other compensation, and benefits information is accurate as of the date of this posting. Cognizant reserves the right to modify this information at any time, subject to applicable law.

Cog2025

Cognizant is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.