Appeals and Complaints Specialist

Job Summary

A company is looking for an Appeals & Complaints Specialist II.

Key Responsibilities

• Act as the main point of contact for resolving internal and external appeals and complaints
• Analyze and process appeal requests and complaints related to clinical services and benefit provisions
• Document all activities and maintain compliance with regulatory standards

Required Qualifications

• High school diploma or equivalent required
• 3 or more years of job-related experience
• 2 - 3 years of experience interacting with customers and clients
• Strong knowledge of appeals processes and ability to work autonomously
• Experience with general computer software, including Outlook, Excel, and MS Word