Healthcare Appeals Specialist

Job Summary

Healthcare Appeals Specialist is a full-time remote position responsible for reviewing, analyzing, and processing complaints and appeals regarding dental and vision services, while communicating with internal and external entities to resolve complex payment disputes and quality of care issues.

Key Responsibilities

• Analyze, triage, investigate, and process appeals and complaints from members, providers, and state agencies
• Communicate effectively with internal staff and providers to resolve various appeals, complaints, and grievances
• Maintain compliance with regulatory standards and accurately document all appeal and complaint activities

Required Qualifications

• High school diploma or equivalent required
• 1+ years of job-related experience, including customer interaction and billing
• Knowledge of general computer software, including Outlook, Excel, and MS Word
• Ability to work overtime as needed
• Experience in a healthcare setting preferred