Appeals and Grievance Specialist

Job Summary

A company is looking for an Appeals & Grievance Case Resolution Specialist.

Key Responsibilities

• Manage the full life cycle of member and provider appeals and grievance cases, ensuring timely resolution
• Research and analyze case documentation, and communicate with stakeholders to gather necessary information
• Ensure compliance with federal and state regulatory requirements while documenting all activities accurately

Required Qualifications

• Associate's Degree in Health Administration, Business, or a related field
• 2 to 3 years of experience in healthcare operations, managed care, or grievance/appeals coordination
• Knowledge of medical terminology and regulatory processes preferred
• Familiarity with CMS, Medicaid, or state-regulated appeals processes preferred
• Proficiency in Microsoft Office Suite