Member Appeals Specialist

Job Summary

A company is looking for a Member Appeals Specialist (Remote).

Key Responsibilities

• Triage, categorize, and route incoming member appeals and grievances
• Manage appeals from assignment through resolution while meeting regulatory timelines
• Prepare compliant correspondence and decision notices using established templates

Required Qualifications

• Prior experience handling member appeals in a healthcare or insurance setting
• Ability to manage a consistent caseload within a system of record
• High attention to detail, organization, and reliability in a remote environment
• Comfortable navigating multiple systems and collaborating across virtual teams