Lead Appeals and Grievances Specialist

A company is looking for a Lead Specialist, Appeals & Grievances. Key Responsibilities Lead and organize the Grievance and Appeals Unit's activities, ensuring compliance with regulatory standards Review and evaluate member grievances and appeals, coordinating with appropriate departments for resolution Conduct investigations into escalated issues and provide written responses to member correspondence Required Qualifications High School Diploma or equivalent 3 years of experience in appeals and grievances Minimum of 3 years in an operational managed care environment Health claims processing experience, including knowledge of Medicaid and Medicare guidelines Familiarity with regulatory requirements for appeals and denials

Jun 12, 2025 - 07:30

A company is looking for a Lead Specialist, Appeals & Grievances. Key Responsibilities Lead and organize the Grievance and Appeals Unit's activities, ensuring compliance with regulatory standards Review and evaluate member grievances and appeals, coordinating with appropriate departments for resolution Conduct investigations into escalated issues and provide written responses to member correspondence Required Qualifications High School Diploma or equivalent 3 years of experience in appeals and grievances Minimum of 3 years in an operational managed care environment Health claims processing experience, including knowledge of Medicaid and Medicare guidelines Familiarity with regulatory requirements for appeals and denials