Appeals and Grievances Specialist

Job Summary

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

Key Responsibilities

• Enters denials and requests for appeals into the information system and prepares documentation for further review
• Researches claims issues and assures timeliness and appropriateness of appeals according to guidelines
• Generates and mails denial letters while collaborating with provider and member services to resolve complaints

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
• Proficiency in Microsoft Office suite or applicable software programs
• Effective verbal and written communication skills