Non-Clinical Appeals Specialist

A company is looking for an Appeals & Grievances Non-Clinical Specialist. Key Responsibilities Manage case development and resolution for non-clinical cases, including claim denials and member complaints Research issues, interpret regulations, and make critical decisions within regulatory timeframes Edit and finalize resolution letters while ensuring compliance with policies and procedures Required Qualifications Bachelor's degree from an accredited institution or relevant work experience High school diploma or GED with proven work experience in Managed Care or Health Insurance Experience in appeals processing or claims processing is preferred Familiarity with care management systems, such as Salesforce or TruCare Demonstrated critical thinking and decision-making competencies

Mar 10, 2025 - 22:22

A company is looking for an Appeals & Grievances Non-Clinical Specialist. Key Responsibilities Manage case development and resolution for non-clinical cases, including claim denials and member complaints Research issues, interpret regulations, and make critical decisions within regulatory timeframes Edit and finalize resolution letters while ensuring compliance with policies and procedures Required Qualifications Bachelor's degree from an accredited institution or relevant work experience High school diploma or GED with proven work experience in Managed Care or Health Insurance Experience in appeals processing or claims processing is preferred Familiarity with care management systems, such as Salesforce or TruCare Demonstrated critical thinking and decision-making competencies