Appeals and Grievances Specialist

Job Summary

A company is looking for an Associate Specialist, Appeals & Grievances.

Key Responsibilities

• Enter denials and requests for appeals into the information system and prepare documentation for review
• Research claims issues and assure timeliness and appropriateness of appeals according to guidelines
• Prepare responses to member appeals and grievances, and generate denial letters

Required Qualifications

• At least 1 year of experience in claims or customer/provider service in a health care setting
• Customer service experience
• Organizational and time management skills to manage multiple projects
• Proficiency in Microsoft Office suite or applicable software programs