Appeals Specialist

Job Summary

Supporting the documentation and processing of appeals, the full-time remote Appeals Specialist will manage complex cases, ensuring compliance with state and NCQA requirements while working Eastern Time hours.

Key responsibilities

• Performs data entry to track, log, and process appeals, disputes, and reconsiderations in accordance with regulatory guidelines
• Prepares correspondence and maintains documentation files for appeals, disputes, and reconsiderations
• Reviews and investigates requests to determine necessary follow-up actions and prepares case files with supporting documentation

Required qualifications

• High School diploma or GED
• 1 - 2 years of related experience in appeals, grievances, claims, or regulated casework
• Knowledge of the appeals, disputes, and reconsiderations process preferred