Senior Appeals Specialist

Job Summary

A company is looking for a Senior Specialist, Appeals & Grievances with Member/Medicaid experience.

Key Responsibilities

• Provide senior level support for the research and resolution of complex appeals, grievances, and complaints
• Request and review medical records and documents to determine outcomes and ensure timely responses
• Identify trends in complaints and prepare written responses to provider reconsideration requests

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