Appeals and Grievance Specialist

Job Summary

Requirements

Responsibilities

Qualifications

• Research and provide resolution to issues such as claim denials, member and provider complaints, and reconsideration and redetermination requests.
• Review and respond to complaints, grievances and appeals within the stated time frame for each request.
• Certify that providers and members are reimbursed accordingly using Medicare reimbursement policies and procedures

Qualifications

• Bachelor's Degree
• Minimum 5 years of relevant experience