Member Appeals Specialist

Job Summary

To support member-focused healthcare operations, the contract Member Appeals Specialist will manage appeal cases from initial assignment to final resolution while working remotely, ensuring compliance with regulatory deadlines and delivering exceptional service.

Key responsibilities

• Manage member appeal cases, ensuring all regulatory and internal turnaround requirements are met
• Review and triage incoming appeals, verifying member eligibility and determining necessary documentation
• Prepare and issue member correspondence while maintaining compliance with established policies and guidelines

Required qualifications

• Experience managing member appeals in a health insurance or managed care environment
• Working knowledge of healthcare appeals, grievance processes, and regulatory timelines
• Experience with case management or appeals systems and multiple business applications
• Strong written and verbal communication skills for professional correspondence
• Exceptional organizational skills to manage a high-volume caseload accurately