Appeals Specialist

Job Summary

Managing the timely processing of appeals, the full-time Appeals Specialist will coordinate with members, providers, and internal teams to ensure effective decision-making and resolution of appeals in a remote environment.

Key responsibilities

• Correspond with members and providers through written communication and phone contact as needed
• Coordinate investigations and resolutions of appeals with internal departments and external vendors
• Maintain knowledge of health products and policies to communicate effectively with stakeholders

Required qualifications

• Bachelor's degree or equivalent experience in healthcare, conflict resolution, or a related field
• Strong computer and analytical skills
• Detail-oriented with a focus on data integrity and documentation