Appeals Grievance Specialist

Job Summary

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

Key Responsibilities

• Resolve complex member and provider appeals and grievances
• Support junior staff and contribute to process improvements
• Ensure compliance with federal, state, and organizational regulations

Required Qualifications, Training, and Education

• Bachelor's degree in healthcare, business, or a related field; or equivalent relevant experience required
• Two years of experience in appeals and grievances or a related healthcare/health insurance field required
• Experience in data analysis and reporting required
• Experience in computer applications, including Microsoft Office Suite, required