Appeals and Grievances Specialist

Employer Industry: Health Insurance

• Opportunity for career advancement and growth within the organization
• Flexibility to work remotely from home (reliable internet required)
• Engage in meaningful work by volunteering in local neighborhoods
• Supportive and collaborative work environment
• Chance to make a positive impact on member experiences through the appeals process

• Review all appeals and grievances to determine necessary supporting documentation
• Compile supporting documentation and resolve discrepancies with internal departments or providers
• Communicate with members about the status of their appeals and educate them on the process
• Investigate and summarize findings for assigned benefit-related cases within required time frames
• Document all aspects of the investigation and resolution process in the Appeals and Grievance database

• Minimum of two years of experience working for a health insurance carrier or similar environment
• Excellent communication skills with the ability to interpret insurance plans and regulations
• Strong skills in Word and Excel, along with the ability to research regulations
• High School diploma or equivalent required;
  Associate's degree preferred

• Prior experience in appeals and grievance, customer service, claims, utilization management, or compliance
• Familiarity with state and federal regulations such as Medicare, ERISA, and Office of Commissioner of Insurance regulations

#Health Insurance #Appeals And Grievance  #Remote Work #Career Opportunity #Community Impact

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