Grievance and Appeal Specialist

A company is looking for a Grievance & Appeal Specialist. Key Responsibilities Conduct and document thorough investigations of grievances, complaints, and appeals Ensure accurate documentation of cases in the appeals management system and maintain compliance with reporting requirements Communicate resolutions to members, providers, and clients effectively Required Qualifications High school diploma/GED required; Bachelor's degree in a related field preferred Two plus years of appeals and grievance experience or related experience required Broad knowledge of plan products, processes, and enrollment rules Ability to perform research and evaluate documentation requirements Familiarity with compliance reporting and data validation requirements

Mar 18, 2025 - 21:59

A company is looking for a Grievance & Appeal Specialist. Key Responsibilities Conduct and document thorough investigations of grievances, complaints, and appeals Ensure accurate documentation of cases in the appeals management system and maintain compliance with reporting requirements Communicate resolutions to members, providers, and clients effectively Required Qualifications High school diploma/GED required; Bachelor's degree in a related field preferred Two plus years of appeals and grievance experience or related experience required Broad knowledge of plan products, processes, and enrollment rules Ability to perform research and evaluate documentation requirements Familiarity with compliance reporting and data validation requirements