Expedited Appeals Specialist

Working remotely, the full-time Expedited Appeals Specialist will process complex expedited appeals, ensuring compliance and accuracy under tight deadlines while managing member and provider correspondence and conducting thorough investigations. Key responsibilities Independently perform triage functions to review and evaluate appeal requests, determining eligibility and benefits Conduct thorough investigations of correspondence, preparing detailed case summaries for administrative review Monitor compliance with regulatory requirements and operational standards, ensuring timely resolution of cases Required qualifications Bachelor's degree 3 - 5+ years of related experience, preferably in the health industry and/or compliance Extensive knowledge of claims, enrollment, benefits, and member contracts Proficiency in MS Office applications Ability to mentor specialists and manage complex cases