Appeals and Grievance Specialist

Job Summary

To support a growing remote team, the full-time Appeals and Grievance Specialist will manage and resolve complaints, grievances, and appeals from members and providers while ensuring compliance with applicable requirements.

Key responsibilities

• Manage and resolve complaints, grievances, and appeals from members and providers
• Serve as the primary contact throughout the investigation and resolution process
• Conduct fair, accurate, and timely case investigations while maintaining documentation

Required qualifications

• 1+ year of Medicare Appeals and Grievance or Medicare Claims experience required
• Experience with Medicare Part C or Part D preferred
• Familiarity with Windows-based computer systems
• High School Diploma or equivalent
• Strong technical and keyboarding skills