Appeals and Grievance Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee and address complaints, grievances, and appeals from both members and providers.

• Act as the main point of contact throughout the investigation and resolution process.

• Dispatch acknowledgments and offer clear guidance on the grievance and appeal procedures.

• Collect pertinent information and investigate case specifics to identify a suitable resolution.

• Execute fair, precise, and timely investigations into cases.

• Relay resolutions to relevant internal and external stakeholders.

• Ensure that all necessary documentation is completed and preserved.

• Adhere to established policies, procedures, and regulatory standards.

• Maintain productivity and quality benchmarks within a structured workflow environment.

• Engage on camera during interviews, training sessions, team meetings, and regular check-ins.

⛳️ Requirements

• At least 1 year of experience in Medicare Appeals and Grievance or Medicare Claims is required.

• Experience with Medicare Part C or Part D is preferred.

• Familiarity with Windows-based computer systems and a capacity to learn new applications.

• Strong technical proficiency and keyboarding skills.

• Exceptional verbal and written communication abilities.

• Capability to remain focused and productive in repetitive task-oriented work.

• High School Diploma or equivalent is required.

• Availability for assigned Monday-Friday schedules between 8:00 AM and 5:00 PM Pacific Time.

• Ability to participate on camera during interviews, training sessions, team meetings, and regular check-ins.

• Background checks, previous employment verifications, and education verifications may be conducted based on the position's requirements.

🏝️ Benefits

• Medical, Dental, and Vision coverage.

• Life Insurance.

• Options for Short-Term and Long-Term Disability.

• Flexible Spending Account (FSA).

• Employee Assistance Program.

• 401(k) with employer contributions.

• Paid Time Off (PTO).

• Tuition Reimbursement.

• Weekly pay.

• Remote work arrangement.

• On-camera participation fostering face-to-face collaboration in a supportive team environment.