Healthcare Appeals Specialist

Job Summary

To support a remote team, the full-time Healthcare Appeals Specialist will analyze, triage, and process complaints and appeals related to dental and vision services, while ensuring compliance with regulatory standards and maintaining effective communication with internal and external stakeholders.

Key responsibilities

• Review and process standard and escalated appeals, complaints, and grievances from members, providers, and health plans
• Communicate with internal staff and external entities to resolve complex payment disputes and quality of care issues
• Document all appeal and complaint activities accurately for reporting and compliance purposes

Required qualifications

• High school diploma or equivalent required
• Over 1 year of relevant experience in a healthcare setting, including billing and customer interaction
• Proficiency in general computer software, including Outlook, Excel, and MS Word
• Previous experience processing appeals or complaints in a healthcare environment preferred
• Ability to work overtime and manage time effectively in a remote setting