Member Appeals Specialist

Managing member appeal cases remotely, the contract Member Appeals Specialist will ensure accuracy, compliance, and timely resolution while coordinating incoming appeals and collaborating with cross-functional teams in a highly regulated healthcare environment. Key responsibilities Manage member appeal cases from intake through resolution, ensuring compliance and timely completion Review and coordinate incoming appeals, gathering required documentation and communicating with members as needed Prepare and maintain case documentation and correspondence using established templates and regulatory guidelines Required qualifications Experience managing member appeals in a healthcare or health insurance environment Ability to prioritize and manage a high-volume caseload while meeting regulatory deadlines Strong attention to detail with experience in preparing professional correspondence Excellent written and verbal communication skills, including professional email etiquette Proficiency in navigating multiple systems and willingness to learn new processes and case management platforms