Appeals and Grievances Specialist

A company is looking for a Specialist, Appeals & Grievances. Key Responsibilities Review and resolve member and provider complaints in accordance with regulatory standards Research claims appeals and grievances to determine outcomes and ensure compliance with timelines Prepare appeal summaries and correspondence, documenting findings and trends as needed Required Qualifications High School Diploma or equivalency Minimum of 2 years operational managed care experience Health claims processing background, including knowledge of Medicaid and Medicare Familiarity with regulatory guidelines for appeals and denials

Jun 21, 2025 - 05:40

A company is looking for a Specialist, Appeals & Grievances. Key Responsibilities Review and resolve member and provider complaints in accordance with regulatory standards Research claims appeals and grievances to determine outcomes and ensure compliance with timelines Prepare appeal summaries and correspondence, documenting findings and trends as needed Required Qualifications High School Diploma or equivalency Minimum of 2 years operational managed care experience Health claims processing background, including knowledge of Medicaid and Medicare Familiarity with regulatory guidelines for appeals and denials