Grievance and Appeal Specialist

Job Summary

A company is looking for a Grievance & Appeal Specialist.

Key Responsibilities

• Conduct and document thorough investigations of grievances, complaints, and appeals
• Ensure accurate documentation of cases in the appeals management system and maintain compliance with reporting requirements
• Communicate resolutions to members, providers, and clients effectively

Required Qualifications

• High school diploma/GED required; Bachelor's degree in a related field preferred
• Two plus years of appeals and grievance experience or related experience required
• Broad knowledge of plan products, processes, and enrollment rules
• Ability to perform research and evaluate documentation requirements
• Familiarity with compliance reporting and data validation requirements