Grievance and Appeals Specialist

To ensure compliance with regulatory standards, the full-time remote Grievance and Appeals Specialist will manage appeals within specified timeframes, maintain and revise policies and procedures, and support contractual obligations in a healthcare environment. Key responsibilities Handle and address appeals received in accordance with contractual obligations Maintain, revise, and implement policies and procedures to ensure compliance Collaborate with various stakeholders to resolve issues and improve processes Required qualifications High School Diploma or GED Minimum two years of medical claims experience in a health insurance environment Thorough knowledge of Medicare, CMS guidelines, and claims determination Proficient in MS Suite, including Word, Excel, and Outlook Ability to work in a fast-paced, customer service-driven environment