Lead Appeals Specialist

Job Summary

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

Key Responsibilities

• Serve as team lead for the submission, intervention, and resolution of appeals, grievances, and complaints
• Train new employees and provide guidance on complex appeals and grievances
• Research and resolve escalated issues, preparing appeal summaries and documentation for tracking data

Required Qualifications

• At least 3 years of managed care experience in a relevant environment
• Health claims processing experience, including knowledge of Medicaid and Medicare guidelines
• Strong customer service experience
• Proficiency in Microsoft Office suite or applicable software programs
• Strong organizational and time management skills