Lead Appeals Specialist

Job Summary

A company is looking for a Lead Specialist, Appeals & Grievances.

Key Responsibilities

• Serves as team lead for the submission, intervention, and resolution of appeals, grievances, and complaints
• Trains new employees and provides guidance on complex appeals and grievances
• Researches and resolves escalated issues, prepares appeal summaries, and ensures compliance with regulatory requirements

Required Qualifications

• At least 3 years of managed care experience in a call center, appeals, and/or claims environment
• Health claims processing experience, including coordination of benefits and eligibility criteria
• Experience with Medicaid and Medicare claims denials and appeals processing
• Strong organizational and time management skills
• Proficiency in Microsoft Office suite or applicable software programs