Appeals Specialist II
Virtual Vocations Inc
Supporting the documentation and processing of appeals, the full-time Appeals Specialist II will manage appeals, disputes, and reconsiderations to ensure compliance with state and NCQA requirements while working remotely. Key responsibilities Perform data entry to track, log, and process appeals, disputes, and reconsiderations according to regulatory guidelines Prepare correspondence and maintain documentation files for appeals, disputes, and reconsiderations Review and investigate requests to determine necessary follow-up actions and ensure timely decisions Required qualifications High School diploma or GED 1 - 2 years of related experience Knowledge of appeals, disputes, and reconsiderations processes preferred Experience with No Surprises Act (NSA) Open Negotiation Requests (ONRs) and Independent Dispute Resolution (IDR) preferred Authorization to work in the U.S. without the need for employment-based visa sponsorship
Vacancy posted 4 days ago
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