Appeals Specialist II

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Oversee designated appeals, grievances, and/or complaint cases from initial intake to final resolution.

• Conduct investigations by collecting documentation, interviewing relevant stakeholders, and analyzing the findings.

• Assess case information to identify suitable resolutions and necessary actions.

• Draft and dispatch acknowledgment and resolution letters within stipulated time frames.

• Maintain comprehensive case files in compliance with regulatory and accreditation standards.

⛳️ Requirements

• High school diploma or GED with six (6) years of experience in the Mental Health, Developmental Disabilities, and Substance Use services field; OR an Associate's degree with four (4) years of relevant experience; OR a Bachelor's degree with two (2) years of experience in the same field; OR a comparable combination of education and experience.

• A valid driver’s license is required.

• Candidates must reside in North Carolina.

• Ability to travel within the catchment area as necessary.

• Must be legally authorized to work in the United States without the need for employment sponsorship, both now and in the future.

• Preferred: Experience with provider claims, provider networks, or provider sanctions.

• All applicants must successfully pass a drug test as a prerequisite for employment.

🏝️ Benefits

• Competitive benefits package.

• Options for remote work available for most positions.

• Flexible work schedules for certain roles with management approval.

• Health Insurance with no premium required for employee coverage.

• Flexible Spending Accounts available.

• Enjoy 24 days of Paid Time Off (PTO) plus 12 paid holidays during your first year.

• Participation in the NC Local Government Retirement Pension (defined-benefit plan).

• 401k plan featuring a 5% employer match with immediate vesting.

• Qualifying employer for Public Service Loan Forgiveness (PSLF).

• Quarterly stipend provided for remote work supplies.