Entry-Level Appeals Specialist

Job Summary

A company is looking for an Associate Specialist, Appeals & Grievances.

Key Responsibilities

• Review and resolve member and provider complaints, ensuring compliance with CMS standards
• Research claims issues and prepare documentation for appeals and grievances
• Generate denial letters and maintain statistics and reporting related to appeals and grievances

Required Qualifications

• At least 1 year of experience in claims or customer/provider service in a healthcare setting
• Organizational and time management skills to manage multiple projects
• Proficiency in Microsoft Office suite or applicable software programs
• Experience in a managed care organization or medical office is preferred
• Completion of a healthcare-related vocational program is a plus