Appeals and Grievances Specialist

Job Summary

Providing entry-level support for claims activities, the full-time Associate Specialist, Appeals & Grievances will review and resolve member and provider complaints, ensuring compliance with CMS standards while working onsite.

Key responsibilities

• Enter denials and requests for appeals into the information system and prepare documentation for further review
• Research claims issues using available systems and resources, ensuring timely and appropriate appeals according to guidelines
• Prepare responses to member appeals and grievances, and generate and mail denial letters

Required qualifications

• At least 1 year of experience in claims or customer/provider service in a healthcare setting, or equivalent education and experience
• Proficiency in Microsoft Office suite and applicable software programs
• Strong organizational and time management skills to manage multiple projects and tasks
• Effective verbal and written communication skills