Appeals and Grievances Specialist - Portland Maine

Company: VirtualVocations
Location: Portland, Maine
Posted On: 01/18/2025

A company is looking for a Specialist, Appeals & Grievances.



Key Responsibilities

Review and resolve member and provider complaints in compliance with regulatory standards
Research claims appeals and grievances, ensuring timely and appropriate responses
Prepare appeal summaries and correspondence, documenting findings and trends as necessary


Required Qualifications

High School Diploma or equivalency
Minimum 2 years of operational managed care experience
Experience in health claims processing, including coordination of benefits and eligibility criteria
Familiarity with Medicaid and Medicare claims denials and appeals processing More...

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