Member Appeals Specialist

Job Summary

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

Key Responsibilities

• Triage, categorize, and assign incoming member appeals and grievances while maintaining accuracy and timeliness
• Manage end-to-end case processing, including eligibility review and adherence to regulatory turnaround times
• Draft and issue acknowledgment letters and appeal determination notices using standardized templates

Qualifications

• 2+ years of experience handling member appeals, preferably in healthcare or insurance
• Ability to manage a high-volume caseload within a structured case management system
• High attention to detail with the ability to follow processes and ensure compliance
• Self-motivated and collaborative, with the ability to work effectively in a remote environment