Appeals and Grievances Specialist
Company: VirtualVocations
Location: Amarillo
Posted on: November 1, 2024
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Job Description:
A company is looking for an Appeals and Grievances Specialist to
ensure timely resolutions to member complaints and appeals in
compliance with regulatory requirements.
Key Responsibilities
Review and process member appeals related to healthcare services
and claims
Conduct investigations of member appeals and grievances,
collaborating with internal departments
Maintain detailed case documentation and prepare reports on appeals
and grievances activity
Required Qualifications and Education
Bachelor's degree in healthcare administration, business, public
health, or a related field preferred
2+ years of experience in healthcare appeals and grievances,
claims, or related member services roles
Familiarity with health plan operations and regulatory compliance
for Medicare, Medicaid, and commercial insurance
Strong knowledge of healthcare regulations and managed care
policies
Proficiency in Microsoft Office and healthcare management
systems
Keywords: VirtualVocations, Amarillo , Appeals and Grievances Specialist, Other , Amarillo, Texas
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