Member Appeals Specialist

Job Summary

Managing member appeal cases remotely, the contract Member Appeals Specialist will ensure accuracy, compliance, and timely resolution while coordinating incoming appeals and collaborating with cross-functional teams in a highly regulated healthcare environment.

Key responsibilities

• Manage member appeal cases from intake through resolution, ensuring compliance and timely completion
• Review and coordinate incoming appeals, gathering required documentation and communicating with members as needed
• Prepare and maintain case documentation and correspondence using established templates and regulatory guidelines

Required qualifications

• Experience managing member appeals in a healthcare or health insurance environment
• Ability to prioritize and manage a high-volume caseload while meeting regulatory deadlines
• Strong attention to detail with experience in preparing professional correspondence
• Excellent written and verbal communication skills, including professional email etiquette
• Proficiency in navigating multiple systems and willingness to learn new processes and case management platforms