Appeals Specialist
Listed on 2026-09-13
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Healthcare
Healthcare Administration, Healthcare Management
Are you an experienced healthcare professional with a background in Managed Care, Appeals & Grievances, and Claims Review
? We are seeking a detail-oriented Appeals & Grievance Specialist II to join a leading health plan and support member and provider issue resolution.
Research and resolve member and provider complaints, appeals, and grievances
Review claim denials, reconsiderations, and redetermination requests
Interpret benefits and analyze claims information
Ensure compliance with state and federal healthcare regulations
Collaborate with cross-functional teams for timely issue resolution
Track, trend, and report appeal and grievance data
Identify root causes and recommend process improvements
Required Qualifications:3+ years of Appeals & Grievance experience within a Managed Care Plan
Strong customer service and communication skills
Experience with claims review and benefit interpretation
Knowledge of CPT and ICD coding
Excellent analytical and problem-solving abilities
#Hiring #Appeals And Grievances #Managed Care #Healthcare Jobs #Claims Review #Health Plan #IrvingTX #Healthcare Careers #Open To Work #Recruitment
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