Appeals and Grievance Specialist

Job Summary

A company is looking for an Appeals & Grievance Specialist I.

Key Responsibilities

• Manage and resolve member and provider appeals and grievances
• Investigate, document, and facilitate resolutions while ensuring satisfaction
• Ensure compliance with regulatory standards throughout the process

Required Qualifications, Training, and Education

• Bachelor's degree in healthcare, business, or a related field, or equivalent relevant experience
• Experience in computer applications, including Microsoft Office Suite
• Experience in appeals and grievances is strongly preferred
• Familiarity with healthcare laws and regulations related to appeals and grievances
• Proficiency in case management software and ability to adapt to new technology