Appeals and Complaints Specialist

Job Summary

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

Key Responsibilities

• Analyze, investigate, and process appeals and complaints from members, providers, and state agencies
• Act as a liaison and subject matter expert for escalated issues between the appeals department and clients
• Document appeal and complaint activities for reporting and collaborate with internal departments to maintain effective relationships

Required Qualifications, Training, and Education

• High school diploma or equivalent required
• 2+ years of experience in complaints, appeals, and grievances processing for a managed care program
• Advanced knowledge in MS Word, Excel, and Outlook
• Ability to compose communication letters efficiently and accurately
• Experience in managing data entry and time management tasks