Appeals and Grievance Specialist

Managing the full life cycle of member and provider appeals and grievance cases, the full-time Appeals and Grievance Specialist will conduct case intake, investigation, and documentation to ensure timely resolution while working remotely. Key responsibilities Research and analyze case documentation to clarify appeal intent and gather necessary information Collaborate with internal departments to resolve cases and identify compliance issues requiring escalation Ensure case handling meets federal and state regulatory requirements while maintaining confidentiality and documentation standards Required qualifications Associate's Degree in Health Administration, Business, or a related field preferred High School Diploma or GED required 2 to 3 years of experience in healthcare operations, managed care, or grievance/appeals coordination Knowledge of medical terminology, benefit interpretation, and regulatory processes preferred Proficiency in Microsoft Office Suite (Word, Excel, Outlook, etc.)