Grievance and Appeals Specialist

Job Summary

To ensure compliance with regulatory standards, the full-time remote Grievance and Appeals Specialist will manage appeals within specified timeframes, maintain and revise policies and procedures, and support contractual obligations in a healthcare environment.

Key responsibilities

• Handle and address appeals received in accordance with contractual obligations
• Maintain, revise, and implement policies and procedures to ensure compliance
• Collaborate with various stakeholders to resolve issues and improve processes

Required qualifications

• High School Diploma or GED
• Minimum two years of medical claims experience in a health insurance environment
• Thorough knowledge of Medicare, CMS guidelines, and claims determination
• Proficient in MS Suite, including Word, Excel, and Outlook
• Ability to work in a fast-paced, customer service-driven environment