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Grievance and Appeals Specialist
Job in
Meridian, Ada County, Idaho, 83680, USA
Listed on 2026-10-11
Listing for:
Manpower, Inc.
Full Time
position Listed on 2026-10-11
Job specializations:
-
Healthcare
Healthcare Administration, Healthcare Management
Job Description & How to Apply Below
Our client, a leading healthcare organization, is seeking a Grievance & Appeals Specialist I to join their team. As a Grievance & Appeals Specialist I, you will be part of the healthcare operations department supporting member and provider relations. The ideal candidate will have strong analytical skills, excellent communication abilities, and a detail-oriented mindset, which will align successfully in the organization.
Job Title: Grievance and Appeals Specialist
Location: Meridian,
Shift: Monday-Friday | 8:00 AM-5:00 PM
What's the Job?- Investigate, analyze, and manage member appeals and grievance cases to ensure timely resolution.
- Ensure cases are accurately classified, categorized, and documented in compliance with regulatory standards.
- Research complex issues and determine if additional information is needed to support decision-making processes.
- Prepare detailed case histories for committee reviews, audits, and regulatory compliance purposes.
- Interpret and apply business rules, policies, benefit plans, and contract language effectively.
- Minimum of 3 years of experience in healthcare operations, claims, appeals, or customer service.
- Strong verbal and written communication skills to effectively interact with members and providers.
- Knowledge of medical terminology, ICD-10, and CPT coding systems.
- Experience interpreting individual and group contract language.
- Strong analytical, investigative, and problem-solving skills to handle complex cases.
- Claims processing experience preferred.
- Opportunity to work in a dynamic healthcare environment committed to making a positive impact.
- Engage in meaningful work that supports member and provider satisfaction.
- Collaborate with a dedicated team of professionals in a supportive setting.
- Gain valuable experience in healthcare compliance and regulatory standards.
- Be part of an organization that values diversity and inclusion.
- Medical and Prescription Drug Plans
- Supplemental Life Insurance
- Short Term Disability Insurance
- 401(k)
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