Senior Appeals Representative

Job Summary

Working remotely, the full-time Senior Appeals Representative will manage end-to-end processes for analyzing and resolving written clinical or administrative appeal requests, ensuring timely and accurate case resolution while adhering to regulatory guidelines.

Key responsibilities

• Research and resolve written appeals submitted by consumers and providers
• Ensure proper categorization of appeals and obtain necessary documentation for case review
• Communicate appeal information to members or providers within required timeframes

Required qualifications

• High School Diploma / GED or equivalent work experience
• 2+ years of experience with analyzing and solving appeals and grievances or in a healthcare setting with claims knowledge
• Proficiency with computer systems and ability to navigate new software
• Ability to work full-time (40 hours/week) during normal business hours with flexibility for overtime or weekends