Appeals Reviewer

Job Summary

Working remotely on a contract basis, the Appeals Reviewer will analyze and research medical grievances and appeals for final resolution while maintaining knowledge of multiple systems and ensuring compliance with relevant standards.

Key responsibilities

• Perform analysis and research of medical grievance and appeal requests, ensuring compliance with State, Federal, and URAC standards
• Review medical records to determine if they meet the required supporting information for appeals
• Monitor appeals and grievances, identifying trends or patterns and reporting findings to management

Required qualifications

• High School Diploma or equivalent required
• 1+ year of claims processing, appeals review, or grievances review experience required
• Experience operating computer software without supervision is essential
• Knowledge of contract benefits is preferred