Appeals and Grievances Specialist

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

Key Responsibilities Facilitates research and resolution of appeals, disputes, grievances, and complaints from members and providers Requests and reviews medical records and documents to determine appropriate responses to claims appeals Prepares appeal summaries and correspondence, documenting findings in accordance with regulatory requirements

Required Qualifications At least 2 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 Customer service experience Proficiency in Microsoft Office suite or applicable software programs