Medicare Advantage Appeals Specialist

Job Summary

Seeking a full-time Medicare Advantage Appeals Specialist, this remote position will manage and resolve member and provider appeals and grievances, ensuring compliance and quality outcomes while delivering an exceptional member experience.

Key responsibilities

• Investigate and resolve member and provider appeals and grievances in a timely and compliant manner
• Manage cases from intake through final resolution, including documentation and communication with stakeholders
• Generate reports and provide recommendations for quality improvement initiatives and operational enhancements

Required qualifications

• High school diploma or GED required
• Minimum of three years of experience managing Medicare Advantage appeals and grievances
• Experience working for a Medicare Advantage health plan
• Working knowledge of Medicare Advantage regulations and appeals processes
• Strong written communication skills, including the ability to prepare professional correspondence and case documentation