Appeals Specialist I

Job Summary

Working remotely, the full-time Appeals Specialist I will analyze appeals and grievance correspondence, manage information tracking, and facilitate the processing of appeals for the Commercial line of business.

Key responsibilities

• Prioritize and analyze appeal and grievance requests, ensuring accurate data entry and compliance with processing guidelines
• Communicate with internal and external stakeholders to request documentation and provide updates on appeals and grievances
• Assist with unit projects and continuous improvement initiatives related to the appeals and grievance processes

Required qualifications

• High School Diploma or GED
• 3 years of experience in managed care, health care, or insurance payor environments
• Knowledge of medical terminology
• Strong organizational and analytical skills
• Ability to meet deadlines and manage multiple customer service demands