Grievance Appeals Specialist

Job Summary

A company is looking for a Grievance & Appeals Specialist II.

Key Responsibilities

• Review and prepare appeals for clinical review, ensuring proper documentation and tracking
• Attend Appeals Committee meetings and maintain records of appeal outcomes
• Process various types of appeals and identify potential fraud and abuse

Required Qualifications

• High school diploma or equivalent required; Associate's Degree preferred
• Minimum of two (2) years of experience in healthcare customer service, claims, or compliance
• Familiarity with Medicaid and the healthcare field
• Intermediate skills in Microsoft Word and Excel
• No licensure or certification required