Senior Appeals Specialist

Job Summary

A company is looking for a Senior Specialist, Appeals & Grievances.

Key Responsibilities

• Provide senior level support for researching and resolving complex appeals, grievances, and complaints from members and providers
• Request and review medical records and formulate conclusions to determine appropriate responses
• Prepare appeal summaries and correspondence, documenting findings in compliance with regulatory requirements

Required Qualifications

• At least 3 years of managed care experience in a call center, appeals, and/or claims environment
• Health claims processing experience, including coordination of benefits and eligibility criteria
• Experience with Medicaid and Medicare claims denials and appeals processing
• Strong organizational and time management skills
• Proficiency in Microsoft Office suite or applicable software programs