Member Appeals Specialist

Job Summary

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

Key Responsibilities

• Triage and categorize incoming member appeals and grievances for accurate routing and timely handling
• Manage appeals from intake through resolution, including eligibility and timeliness evaluation
• Prepare and issue required correspondence using standardized templates with case-specific adjustments

Required Qualifications

• Prior experience handling member appeals, preferably within pre-service or pharmacy coverage contexts
• Demonstrated ability to manage caseloads within a system of record and follow defined workflows
• Strong written and verbal communication skills, with professional email etiquette
• High attention to detail, reliability, and commitment to accuracy in compliance-driven work
• Comfort working in a fully remote, team-oriented environment using multiple business systems